Objective: Older people approaching the end of life are at a high risk for adverse drug reactions. Approaching the end of life should change the therapeutic aims, triggering a reduction in the number of drugs.The main aim of this study is to describe the preventive and symptomatic drug treatments prescribed to patients discharged with a limited life expectancy from internal medicine and geriatric wards. The secondary aim was to describe the potentially severe drug-drug interactions (DDI). Materials and Methods: We analyzed Registry of Polytherapies Societa Italiana di Medicina Interna (REPOSI), a network of internal medicine and geriatric wards, to describe the drug therapy of patients discharged with a limited life expectancy. Results: The study sample comprised 55 patients discharged with a limited life expectancy. Patients with at least 1 preventive medication that could be considered for deprescription at the end of life were significantly fewer from admission to discharge (n = 30; 54.5% vs. n = 21; 38.2%; p = 0.02). Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, lipid-lowering drugs, and clonidine were the most frequent potentially avoidable medications prescribed at discharge, followed by xanthine oxidase inhibitors and drugs to prevent fractures. Thirty-seven (67.3%) patients were also exposed to at least 1 potentially severe DDI at discharge. Conclusion: Hospital discharge is associated with a small reduction in the use of commonly prescribed preventive medications in patients discharged with a limited life expectancy. Cardiovascular drugs are the most frequent potentially avoidable preventive medications. A consensus framework or shared criteria for potentially inappropriate medication in elderly patients with limited life expectancy could be useful to further improve drug prescription.

Need for Deprescribing in Hospital Elderly Patients Discharged with a Limited Life Expectancy: The REPOSI Study

Domenico Prisco
Membro del Collaboration Group
;
Elmo Mannarino
Membro del Collaboration Group
;
Graziana Lupattelli
Membro del Collaboration Group
;
Vanessa Bianconi
Membro del Collaboration Group
;
Francesco Paciullo
Membro del Collaboration Group
;
Oliviero Olivieri
Membro del Collaboration Group
;
Maria Domenica Cappellini
Membro del Collaboration Group
;
Federica Conti
Membro del Collaboration Group
;
Lucia Sofia
Membro del Collaboration Group
;
Maria Carbone
Membro del Collaboration Group
;
Paolo Mazzola
Membro del Collaboration Group
;
Marco Bertolotti
Membro del Collaboration Group
;
Elisa Pellegrini
Membro del Collaboration Group
;
Roberto Leonardi
Membro del Collaboration Group
;
Massimo Mattioli
Membro del Collaboration Group
;
Lorenzo Biondi
Membro del Collaboration Group
;
Maria Pasquale
Membro del Collaboration Group
;
Giuseppe Montalto
Membro del Collaboration Group
;
Patrizia Mecocci
Membro del Collaboration Group
;
Carmelinda Ruggiero
Membro del Collaboration Group
;
Virginia Boccardi
Membro del Collaboration Group
;
Roberto Tarquini
Membro del Collaboration Group
;
Riccardo Volpi
Membro del Collaboration Group
;
2019-01-01

Abstract

Objective: Older people approaching the end of life are at a high risk for adverse drug reactions. Approaching the end of life should change the therapeutic aims, triggering a reduction in the number of drugs.The main aim of this study is to describe the preventive and symptomatic drug treatments prescribed to patients discharged with a limited life expectancy from internal medicine and geriatric wards. The secondary aim was to describe the potentially severe drug-drug interactions (DDI). Materials and Methods: We analyzed Registry of Polytherapies Societa Italiana di Medicina Interna (REPOSI), a network of internal medicine and geriatric wards, to describe the drug therapy of patients discharged with a limited life expectancy. Results: The study sample comprised 55 patients discharged with a limited life expectancy. Patients with at least 1 preventive medication that could be considered for deprescription at the end of life were significantly fewer from admission to discharge (n = 30; 54.5% vs. n = 21; 38.2%; p = 0.02). Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, lipid-lowering drugs, and clonidine were the most frequent potentially avoidable medications prescribed at discharge, followed by xanthine oxidase inhibitors and drugs to prevent fractures. Thirty-seven (67.3%) patients were also exposed to at least 1 potentially severe DDI at discharge. Conclusion: Hospital discharge is associated with a small reduction in the use of commonly prescribed preventive medications in patients discharged with a limited life expectancy. Cardiovascular drugs are the most frequent potentially avoidable preventive medications. A consensus framework or shared criteria for potentially inappropriate medication in elderly patients with limited life expectancy could be useful to further improve drug prescription.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11391/1538261
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