Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing

Antonio San-José, Antonia Agustí, Xavier Vidal, Francesc Formiga, Alfonso López-Soto, Antonio Fernández-Moyano, Juana García, Nieves Ramírez-Duque, Olga H. Torres, José Barbé

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© 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. Purpose: This study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria.Methods: An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75 years and olderwere randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteriawere used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicatorswere used. An analysis to assess factors associated with IP was performed.Results: 672 patients [median age (Q1Q3) 82 (7986) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1Q3 713). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria thanwith the Beers criteria (p < 0.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p < 0.001) was observed. Polypharmacy (≥10 medicines) was the strongest predictor of IP [OR = 11.34 95% confidence interval (CI) 4.9625.94], PIMs [OR = 14.16, 95% CI 6.4431.12], Beers-listed PIMs [OR = 8.19, 95% CI 3.0122.28] and STOPP-listed PIMs [OR = 8.21, 95% CI 3.4719.44]. PIMs was the strongest predictor of PPOs [OR = 2.79, 95% CI 1.814.28].Conclusions: A high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different.
Original languageEnglish
Pages (from-to)710-716
JournalEuropean Journal of Internal Medicine
Issue number8
Publication statusPublished - 1 Jan 2014


  • Inappropriate prescribing
  • Older multimorbidity patients
  • Polypharmacy
  • Potentially inappropriate medicines
  • Potentially Prescribing Omissions


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