title: Clinical impact of potentially inappropriate medications during hospitalization of acutely ill older patients with multimorbidity.
abstract: OBJECTIVE
  To identify potentially inappropriate medications (PIMs), to compare drug changes between geriatric and other medical wards, and to investigate the clinical impact of PIMs in acutely hospitalized older adults.
  
  
  METHODS
  Retrospective study of 232 home-dwelling, multimorbid older adults (aged ≥75 years) acutely admitted to Vestfold Hospital Trust, Norway.
  
  
  METHODS
  PIMs were identified by Norwegian general practice (NORGEP) criteria and Beers' 2012 criteria. Clinical correlates were laboratory measures, functional and mental status, physical frailty, and length of stay.
  
  
  RESULTS
  Mean (SD) age was 86 (5.7) years, and length of stay was 6.5 (4.8) days. During the stay, the mean number of drugs used regularly changed from 7.8 (3.6) to 7.9 (3.6) (p = 0.22), and drugs used pro re nata (prn) changed from 1.4 (1.6) to 2.0 (1.7) (p < 0.001). The prevalence of any PIM changed from 39.2% to 37.9% (p = 0.076), while anticholinergics and benzodiazepines were reduced significantly (p ≤ 0.02). The geriatric ward reduced drug dosages (p < 0.001) and discontinued PIMs (p < 0.001) significantly more often than other medical wards. No relations between number of PIMS and clinical outcomes were identified, but the concomitant use of ≥3 psychotropic/opioid drugs was associated with reduced hand-grip strength (p ≤ 0.012).
  
  
  CONCLUSIONS
  Hospitalization did not change polypharmacy or PIMs. Drug treatment was more appropriate on the geriatric than other medical wards. No clinical impact of PIMs was observed, but prescribers should be vigilant about concomitant prescription of ≥3 psychotropics/opioids.
  
  
  CONCLUSIONS
  Acute hospitalization of older patients with multimorbidity did not increase polypharmacy or potentially inappropriate medications. Prescription of anticholinergics and benzodiazepines was significantly reduced. The geriatric ward reduced drug dosages and discontinued potentially inappropriate medications more frequently than the other medical wards.
authors.affiliation: a Department of Geriatric Medicine , Vestfold Hospital Trust , Tønsberg , Norway .|b Norwegian National Advisory Unit on Ageing and Health , Tønsberg , Norway .|c Geriatric Psychiatry Research Network, Telemark Hospital Trust and Vestfold Hospital Trust , Norway .
authors.forename: Hege
authors.initials: H
authors.lastname: Kersten
authors.affiliation: a Department of Geriatric Medicine , Vestfold Hospital Trust , Tønsberg , Norway .|b Norwegian National Advisory Unit on Ageing and Health , Tønsberg , Norway .
authors.forename: Lara T
authors.initials: LT
authors.lastname: Hvidsten
authors.affiliation: d The Hospital Pharmacies, Vestfold, South-Eastern Norway Regional Health Authority , Norway .
authors.forename: Gløer
authors.initials: G
authors.lastname: Gløersen
authors.affiliation: e Institute of Clinical Medicine, University of Oslo , Oslo , Norway , and.|f Department of Geriatric Medicine , Oslo University Hospital , Oslo , Norway.
authors.forename: Torgeir Bruun
authors.initials: TB
authors.lastname: Wyller
authors.affiliation: a Department of Geriatric Medicine , Vestfold Hospital Trust , Tønsberg , Norway .|e Institute of Clinical Medicine, University of Oslo , Oslo , Norway , and.
authors.forename: Marte Sofie
authors.initials: MS
authors.lastname: Wang-Hansen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D057915:Drug Substitution / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D009664:Norway; D019338:Polypharmacy; D012189:Retrospective Studies
keywords: Aged; Norway; clinical pharmacists; general practice; general practitioners; geriatric assessment; inappropriate prescribing; polypharmacy; psychotropic drugs