title: The association of change in medication regimen and use of inappropriate medication based on beers criteria with adverse outcomes in Japanese long-term care facilities.
abstract: OBJECTIVE
  To describe medication use including potentially inappropriate medication (PIM) and examine the association between adverse outcomes and patient factors including PIM use in Japanese elderly patients in long-term care facilities.
  
  
  METHODS
  This was a retrospective cohort study of 470 patients in 53 Geriatric Health Service Facilities and 44 Sanatorium Type Medical Care Facilities for the Elderly Requiring Long Term Care. Standardized forms were used to collect information including oral and parenteral medication use on admission, and 1 month and 3 months after admission. PIMs were determined by the 2003 or 2012 Beers criteria. Adverse outcomes were any medical events leading to emergency department transfer, hospitalization to acute care hospitals or death.
  
  
  RESULTS
  A total of 2,227 oral medications and 197 parenteral medications were prescribed for 470 patients on admission. PIM exposure based on the 2003 and 2012 Beers criteria was observed in 11.9% and 37.5%, respectively. Adverse outcomes within 3 months after admission were observed in 8.9% of the entire cohort, and were associated with age, sex, facility type and number of parenteral medications on admission. Adverse outcomes between one and three months after admission were associated with age, sex, number of parenteral medications at one month, and a change in the number of oral and parenteral medications within one month after admission. PIM exposure was not associated with adverse outcomes in any models.
  
  
  CONCLUSIONS
  Use of PIM was prevalent in long-term care facilities. Our findings support the importance of comprehensive assessment of medication regimens including parenteral medication. Geriatr Gerontol Int 2017; 17: 591-597.
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Shinya
authors.identifier: http://orcid.org/0000-0001-5762-4066
authors.initials: S
authors.lastname: Ishii
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Kojima
authors.affiliation: Ube Kinen Hospital, Ube, Japan.|Kurashiki Sweet Hospital, Kurashiki, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ezawa
authors.affiliation: Japan Association of Geriatric Health Services Facilities, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Higashi
authors.affiliation: The Chikeikai medical corporation, Fukui, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Ikebata
authors.affiliation: Japan Association of Medical and Care Facilities, Tokyo, Japan.
authors.forename: Yozo
authors.initials: Y
authors.lastname: Takehisa
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Akishita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007564:Japan; D008134:Long-Term Care; D008297:Male; D000067561:Potentially Inappropriate Medication List; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: adverse drug events; long term care facilities; potentially inappropriate medications