gms | German Medical Science

Background: In the context of an ageing population, drug-related problems, such as potentially inappropriate medications (PIMs), are becoming increasingly relevant. The use of PIM lists is an important tool for increasing medication safety in older adults. As part of the POLAR_MI project, a use case within the Medical Informatics Initiative Germany (MII) (https://www.medizininformatik-initiative.de/en/POLAR), the prevalence of PIM usage and the association between PIM intake and falls were investigated in the hospital setting.

Materials and Methods: The frequency of PIM usage and the association with the adverse event ‘fall’ in patients ≥65 years for the period 2018 to 2021 was analysed in 12 university hospitals locally followed by a meta-analysis of aggregated results. The association with falls was estimated using ICD-10 codes for fractures that led to admission or occurred during hospitalisation. PIMs were defined using 160 of the 177 items from the PRISCUS 2.0 list [1], excluding items requiring dosage specification, dosage form, diagnosis, or duration of use. In general, the inpatient or pre-admission medication of a case was considered. A multivariable logistic regression model, adjusted for age, gender and Charlson Comorbidity Index (excluding age), was used for the association analysis.

Results: The local results from ten sites could be integrated into the meta-analysis, allowing for evaluation of more than 160,000 cases (median age 76 [95% confidence interval (CI): 75.6-76.4] years; women: 45.8% [43.8%-47.8%]). At least one PIM was detected in 37.9% [32.2%-44.1%] of these cases. Zopiclone was the most frequently documented PIM with a proportion of 3.5% [1.6%-7.5%], followed by metoclopramide with 2.7% [1.8%-4.1%] and moxonidine with 2.3% [1.2%-4.6%]. Overall, the use of at least one PIM increased the risk for a fall significantly (adjusted odds ratio 1.3 [1.1-1.6]).

Conclusion: For the first time, it was demonstrated that distributed analyses on the topic of medication safety are feasible within the framework of the MII. The results of the prevalence analysis of PIM , based on the PRISCUS 2.0 list, are consistent with previous analyses in the inpatient area [2]. Furthermore, there was an association between the intake of at least one PIM and falls.

However, PIMs that are more complex to operationalise (particularly in relation to dosages and duration of use) are still challenging within the MII framework. These findings from the POLAR_MI project are relevant for future research projects.