Premium
Potentially Inappropriate Medication Prescriptions for Older Adults with Painful Conditions and Association with Return Emergency Department Visits
Author(s) -
Chukwulebe Steve B.,
Kim Howard S.,
McCarthy Danielle M.,
Courtney D. Mark,
Lank Patrick M.,
Gravenor Stephanie J.,
Dresden Scott M.
Publication year - 2019
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15722
Subject(s) - medicine , emergency department , odds ratio , medical prescription , confidence interval , retrospective cohort study , cohort study , logistic regression , emergency medicine , physical therapy , psychiatry , pharmacology
Objectives To describe the frequency and risk of return visit to the emergency department (ED) by older adults after prescription of any of four potentially inappropriate medication (PIM) classes included in the 2015 Beers Criteria commonly used for the relief of acute pain in the ED. Design Retrospective cohort study. Setting Large urban academic ED from January 1, 2013, to December 31, 2015. Participants Patients age 65 and older discharged from the ED with an initial pain score of 1 or higher (11 822 visits). Measurements Prescriptions for PIM classes were collected from the medical record: nonsteroidal anti‐inflammatory drugs (NSAIDs), benzodiazepines, skeletal muscle relaxants, and opioids. The proportion of patients with ED returns within 9 days were compared by medication class and pain severity (mild, moderate, or severe). Multivariable logistic regression was performed for each pain category to determine adjusted odds ratios (aORs) of ED return. Results Of 11 822 included patients, PIMs were prescribed in 3392 (28.7%): 2550 (21.6%) opioids, 826 (7.0%) NSAIDs, 277 (2.3%) benzodiazepines, and 68 (0.6%) nonbenzodiazepine skeletal muscle relaxants. Total 9‐day ED returns were 1125 (9.5%): mild 7.0%, moderate 8.3%, and severe pain 11.7%. Opioids were not associated with more frequent ED returns for mild or moderate pain, and they were associated with less frequent ED returns for severe pain (9.2% vs 12.7%; p < .001; aOR 0.69; 95% confidence interval [CI] = 0.54‐0.87). Benzodiazepines were associated with more frequent ED returns for patients with moderate pain (15.5% vs 8.2%; p < .01; aOR = 2.01; 95%CI = 1.10‐3.70). Conclusions These results are consistent with recommendations to limit benzodiazepine prescriptions for older adults and that among older adults with severe pain, opioid prescribing is associated with less frequent ED visits within 9 days of discharge. However, this study was not designed to evaluate safety, adverse events, or other important patient‐centered outcomes. J Am Geriatr Soc 67:719–725, 2019.