Use of Potentially Inappropriate Medication and Association with Falls During Hospitalisation: An Analysis Based on Electronic Health Records (POLAR_MI project).

BACKGROUND

In an ageing population, drug-related problems, including potentially inappropriate medications (PIMs), are increasingly relevant. PIM lists are important tools for improving medication safety in older adults.

OBJECTIVE

As part of the POLAR_MI (POLypharmacy, drug interActions, Risks) project, this study aimed to assess the prevalence of PIM and its association with falls in patients aged ≥ 65 years, based on the methods and processes of the Medical Informatics Initiative Germany.

METHODS

A retrospective, distributed analysis of electronic health records (EHRs) (2018-2021) was conducted at ten German university hospitals. PIMs were defined using PRISCUS and EU(7)-PIM lists. Falls were identified using documented fractures as a surrogate. Multivariable logistic regression modelling was applied, adjusting for confounders including age, gender, Charlson Comorbidity Index (CCI) and fall-risk-increasing drugs (FRIDs).

RESULTS

A total of 166,126 cases (median age: 76 years; 45.8% women) were analysed. According to PRISCUS, 12.8% of cases had at least one PIM, with amitriptyline most common (1.1% of all cases). According to EU(7)-PIM, 45.6% of cases were affected, with apixaban most frequent (8.6%). An association between falls and at least one PIM (PRISCUS: adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 0.94-1.55; EU(7)-PIM: aOR 1.01, 95% CI 0.83-1.22) could not be observed. However, FRIDs were associated with falls (PRISCUS: aOR 2.31, 95% CI 1.64-3.27; EU(7)-PIM: aOR 2.43, 95% CI 1.69-3.48).

CONCLUSIONS

In this large multicentre EHR analysis, PIMs were common in older patients, but an association with an increased likelihood of falls could not be observed. In contrast, the well-known association with FRIDs was confirmed. The ongoing digitalisation of German hospitals enables such large-scale data analyses for risk assessment and supports improvements in patient safety.