title: Inappropriate medication prescriptions in elderly adults surviving an intensive care unit hospitalization.
abstract: OBJECTIVE
  To determine types of potentially (PIMs) and actually inappropriate medications (AIMs), which PIMs are most likely to be considered AIMs, and risk factors for PIMs and AIMs at hospital discharge in elderly intensive care unit (ICU) survivors.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary care, academic medical center.
  
  
  METHODS
  One hundred twenty individuals aged 60 and older who survived an ICU hospitalization.
  
  
  METHODS
  Potentially inappropriate medications were defined according to published criteria; a multidisciplinary panel adjudicated AIMs. Medications from before admission, ward admission, ICU admission, ICU discharge, and hospital discharge were abstracted. Poisson regression was used to examine independent risk factors for hospital discharge PIMs and AIMs.
  
  
  RESULTS
  Of 250 PIMs prescribed at discharge, the most common were opioids (28%), anticholinergics (24%), antidepressants (12%), and drugs causing orthostasis (8%). The three most common AIMs were anticholinergics (37%), nonbenzodiazepine hypnotics (14%), and opioids (12%). Overall, 36% of discharge PIMs were classified as AIMs, but the percentage varied according to drug type. Whereas only 16% of opioids, 23% of antidepressants, and 10% of drugs causing orthostasis were classified as AIMs, 55% of anticholinergics, 71% of atypical antipyschotics, 67% of nonbenzodiazepine hypnotics and benzodiazepines, and 100% of muscle relaxants were deemed AIMs. The majority of PIMs and AIMs were first prescribed in the ICU. Preadmission PIMs, discharge to somewhere other than home, and discharge from a surgical service predicted number of discharge PIMs, but none of the factors predicted AIMs at discharge.
  
  
  CONCLUSIONS
  Certain types of PIMs, which are commonly initiated in the ICU, are more frequently considered inappropriate upon clinical review. Efforts to reduce AIMs in elderly ICU survivors should target these specific classes of medications.
authors.affiliation: Rehabilitation and Aged Care Unit Hospital Ancelle, Cremona, Italy. morandi.alessandro@gmail.com
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morandi
authors.forename: Eduard
authors.initials: E
authors.lastname: Vasilevskis
authors.forename: Pratik P
authors.initials: PP
authors.lastname: Pandharipande
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Girard
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Solberg
authors.forename: Erin B
authors.initials: EB
authors.lastname: Neal
authors.forename: Tyler
authors.initials: T
authors.lastname: Koestner
authors.forename: Renee E
authors.initials: RE
authors.lastname: Torres
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Thompson
authors.forename: Ayumi K
authors.initials: AK
authors.lastname: Shintani
authors.forename: Jin H
authors.initials: JH
authors.lastname: Han
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
authors.forename: Donna M
authors.initials: DM
authors.lastname: Fick
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
mesh_terms: D018806:APACHE; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing; D007362:Intensive Care Units; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D010351:Patient Discharge; D016012:Poisson Distribution; D019338:Polypharmacy; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017741:Survivors
keywords: ICU; actually inappropriate medications; older; polypharmacy; potentially inappropriate medications; risk factors