Pattern and factors associated with potentially inappropriate medications to eldery patients presenting to Muhimbili National Hospital-emergency department

Abstract

ABSTRACT. Background: Older adults in Emergency Departments (EDs) often have complex medical demand due to the presence of multiple chronic illnesses, this has led to the use of multiple medication (polypharmacy), causing them to be vulnerable to Potentially Inappropriate Medications, hospitalization, multiple emergency department visits and adverse events. Objectives: To determine the pattern and factors associated with potentially inappropriate medication given to older patients aged 65 years and above who present to Muhimbili National Hospital Emergency Department. Methods: This was a retrospective cross sectional study which obtained data of patients aged ≥65 years who presented from January 2024 to June 2024. Data was extracted from the Wellsoft Electronic Health Record System (EHRS) to Case Report Form (CRF) in Redcap on demographic and clinical data, medication data. Potentially Inappropriate Medications (PIMs) were identified by using Screening Tool of Older Persons Potentially Inappropriate Prescription/ Screening Tool to Alert to Right Treatment (STOPP/START) criteria. Data was then represented by frequencies and mean. Univariate analysis to find association between patient characteristics and PIMs was done. Multivariate analysis to identify independent predictors of PIMs employed by importing all variables with P value less than 0.05 considered significant. Results: A total of 467 elderly patients aged ≥65 years participated in this study, with the mean age of 73.5 years, of which 278 (59.5%) were males. The proportion of PIM use according to STOPP/START criteria version three was 51.6%. Most common PIM pattern were analgesics, the Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) 13.5%, and the gastrointestinal medications Proton Pump Inhibitors (PPIs) 11.5% as identified by STOPP/START criteria. The factors which were independently associated with PIMs after multivariate analysis were night shifts attending doctor, specialist and registrar, The increase in number of complain above 2 and large number of diagnoses which were statistically significant. Conclusion: The study highlights the high proportion of potentially inappropriate medications in elderly patients at emergency departments, with night shift, specialist and registrar, increasing in number of complain and diagnosis being the main factors associated with PIMs. Therefore, emphasizing the need for improved prescribing practices, including electronic prescription systems and regular medication review.