title: Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors.
abstract: BACKGROUND
  Scientific evidence on treatments of chronic diseases in patients 85 years old or older is very limited, as is available information on inappropriate prescription (IP) and its associated factors. The study aimed to describe medicine prescription, potentially inappropriate medicines (PIM) and potentially prescribing omissions (PPO) and their associated factors on this population.
  
  
  METHODS
  In the context of an observational, prospective and multicentric study carried out in elderly patients admitted to seven Spanish hospitals for a year, a sub-analysis of those aged 85 years and over was performed. To assess PIMs, the Beers and STOPP criteria were used, and to assess PPOs, the START and the ACOVE-3 criteria were used. To assess factors associated with IP, a multivariate logistic regression analysis was performed. Patients were selected randomly every week on consecutive days from the hospitalization lists.
  
  
  RESULTS
  A total of 336 patients were included in the sub-analysis with a median (Q1-Q3) age of 88 (86-90) years. The median medicines taken during the month prior to admission was 10 (7-13). Forty-seven point two per cent of patients had at least one Beers-listed PIM, 63.3% at least one STOPP-listed PIM, 53.6% at least one START-listed PPO, and 59.4% at least one ACOVE-3-listed PPO. Use of benzodiazepines in patients who are prone to falls (18.3%) and omission of calcium and vitamin D supplements in patients with osteoporosis (13.3%) were the most common PIM and PPO, respectively. The main factor associated with the Beers-listed and the STOPP-listed PIM was consumption of 10 or more medicines (OR = 5.7, 95% CI 1.8-17.9 and OR = 13.4, 95% CI 4.0-44.0, respectively). The main factors associated with the START-listed PPO was a non-community dwelling origin (OR 2.3, 95% CI 1.0-5.0), and multimorbidity (OR1.8, 95% CI 1.0-3.1).
  
  
  CONCLUSIONS
  Prescribed medicines and PIM and PPO prevalence were high among patients 85 years and over. Benzodiazepine use in those who are prone to falls and omission of calcium and vitamin D in those with osteoporosis were the most frequent PIM and PPO, respectively. Factors associated with PIM and PPO differed with polypharmacy being the most important factor associated with PIM.
authors.affiliation: Internal Medicine Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Àrea General 3ª planta, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain. asanjose@vhebron.net.|Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain. asanjose@vhebron.net.
authors.forename: Antonio
authors.initials: A
authors.lastname: San-José
authors.affiliation: Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Departament of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain. Antonia.ficf@gmail.com.
authors.forename: Antonia
authors.initials: A
authors.lastname: Agustí
authors.affiliation: Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Departament of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain. xvg@icf.uab.cat.
authors.forename: Xavier
authors.initials: X
authors.lastname: Vidal
authors.affiliation: Internal Medicine Service, Hospital Universitari de Bellvitge. Hospitalet de Llobregat, Barcelona, Spain. fformiga@bellvitgehospital.cat.|Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain. fformiga@bellvitgehospital.cat.
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.affiliation: Internal Medicine Service, Hospital San Juan De Dios del Aljarafe, Sevilla, Spain. merxe84@msn.com.|Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain. merxe84@msn.com.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Gómez-Hernández
authors.affiliation: Internal Medicine Service, Hospital General Juan Ramón Jiménez, Huelva, Spain. gamoju@gmail.com.|Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain. gamoju@gmail.com.
authors.forename: Juana
authors.initials: J
authors.lastname: García
authors.affiliation: Internal Medicine Service, Hospital Clínic, Barcelona, Spain. alopez@clinic.ub.es.|Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain. alopez@clinic.ub.es.
authors.forename: Alfonso
authors.initials: A
authors.lastname: López-Soto
authors.affiliation: Internal Medicine Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain. nievesramirezduque@yahoo.es.|Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain. nievesramirezduque@yahoo.es.
authors.forename: Nieves
authors.initials: N
authors.lastname: Ramírez-Duque
authors.affiliation: Internal Medicine Service, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. otorres@santpau.cat.|Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain. otorres@santpau.cat.
authors.forename: Olga H
authors.initials: OH
authors.lastname: Torres
authors.affiliation: Internal Medicine Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Àrea General 3ª planta, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain. jbarbe@vhebron.net.|Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain. jbarbe@vhebron.net.
authors.forename: José
authors.initials: J
authors.lastname: Barbé
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001569:Benzodiazepines / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D017610:Calcium Compounds / Q000627:therapeutic use*; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects / Q000517:prevention & control / Q000706:statistics & numerical data; D008297:Male; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D014807:Vitamin D / Q000627:therapeutic use*
chemical_list: D050071:Bone Density Conservation Agents; D017610:Calcium Compounds; D001569:Benzodiazepines; D014807:Vitamin D