A prospective study on the association between potentially inappropriate prescribing in community-dwelling older adults and all-cause mortality

Introduction: Potentially inappropriate prescribing (PIP), encompassing potentially inappropriate medications (PIMs) and prescribing omissions (PPOs), is prevalent among older adults and consistently associated with adverse health outcomes. However, evidence on its impact on mortality remains limited. We examined associations of PIMs and PPOs with long-term mortality among community-dwelling older adults.

Material and Methods: 1,210 participants from a population-based cohort (1999–2004) were followed for mortality until March 2022. PIMs and PPOs were identified using the 2023 Beers® and the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START) v3 criteria. Cox proportional hazards and Fine-Gray subdistribution hazard models assessed associations between PIP and all-cause and non-cancer mortality, respectively, adjusting for sociodemographic, lifestyle, genetic, and health-related factors.

Results and discussion: The most prevalent morbidities among participants (mean age 72.9±7.4, 52.8% women) were hypertension (49.8%) and cardiovascular diseases (42.3%). PIP was highly prevalent - 81.2% of participants had at least one PIP, with 52.6% having PIMs and 59.3% having PPOs, most commonly from the Cardiovascular System section. Having ≥2 PIMs was significantly associated with about 1.4 times higher risk of non-cancer mortality, while having ≥2 PPOs was associated with double the risk. The negative effects of inappropriate medications were stronger in relatively healthy older adults compared to those in poor health. Exposure to ≥2 PPOs was associated with increased all-cause mortality risk (HR=1.84, 95%CI: 1.24-2.72), while associations were stronger in men (p-for-interaction=0.012).

Conclusion: This research highlights a critical public health issue affecting most older adults living independently in the community. Both over-prescribing risky medications and under-prescribing necessary ones were found to be associated with increased mortality risk. This has important implications for clinical practice, indicating a need for regular medication reviews even in healthy seniors and better systems to help doctors identify and correct prescribing issues.