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.