Implications for practice and future research
It was encouraging to see a reduction in the prevalence of PIMs and PPOs while geriatric rehabilitation inpatients moved from acute admission to discharge but still a large proportion of patients received PIMs and PPOs at discharge from a geriatric rehabilitation. At discharge, patients may not only continue to use PIMs/PPOs from acute admission, but it may also be a site where new inappropriate medications may be introduced.37 These newly added inappropriate medications conferred a higher risk of adverse events compared to chronic inappropriate medications.37 Therefore, designing strategies to reduce the prescription of medications with high risk profile and tailoring deprescription practice would be an important intervention worth considering. The group of PIM medications that may be benefited from the deprescription intervention included psychotropics, fall-risk increasing drugs and other CNS acting agents. Equally important, medications that are beneficial for older people needs to be started or let them to continue at discharge and beyond. However, there should be a balance which medications to prescribe or to deprescribe – for example, in the current study, prescriptions related to CVD medications overall were associated with short-term hospital readmissions, similarly their omission has significantly increased mortality in the long-term. The better approach to optimise CVD medication use in geriatric rehabilitation inpatients is to reduce CVD PIMs (e.g., use of centrally active antihypertensives and use of amiodarone as first-line antiarrhythmic therapy in supraventricular tachyarrhythmias) and continue to prescribe beneficial CVD medications (e.g., use of beta-blockers in patients with ischaemic heart disease, and ACEIs in patients with systolic heart failure and/or documented coronary artery disease) unless contraindications existed. In fact, (de) prescription practice is determined by several internal and external factors, including prescriber’s reluctance to stop medications prescribed by other healthcare providers and a lack of time for comprehensive evaluation of patients.38 Active involvement of patients and their families in the prescribing decision-making process is an important strategy to empower patients in their self-care,39 including designing ways to adopt non-pharmacological approaches or substitute with safer alternatives.
While the occurrence of PIMs offers an opportunity to improve care through deprescription, more studies are needed to assess the feasibility of conducting deprescription intervention to reduce PIMs among geriatric rehabilitation inpatients. Moreover, future studies are required to examine the association between the presence of PIMs and PPOs with medication-related hospital admissions, rather than all-cause readmission.