Sangil Lee , Gabrielle Frediani , Brian C. Lund , Korey Kennelty , Molly Moore Jeffery , Ryan M. Carnahan
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Logistic regression models were used to assess demographic, clinical, and hospital factors associated with the use of any PIMs upon ED discharge.</p></div><div><h3>Results</h3><p>Overall, 5.9% of visits by older adults discharged from the ED included administration or prescriptions for PIMs. Among those who received any PIMs, 25.5% received benzodiazepines, 42.5 % received anticholinergics, 1.4% received nonbenzodiazepine hypnotics, and 0.5% received barbiturates. A multivariable model showed statistically significant associations for age 65 to 74 (OR 1.91, 95% CI 1.39–2.62 vs. age >=75), dementia (OR 0.45, 95% CI 0.21–0.95), lower immediacy (OR 2.45, 95% CI 1.56–3.84 vs. higher immediacy), and Northeastern rural region (OR 0.34, 95% CI 0.21–0.55 vs. Midwestern rural).</p></div><div><h3>Conclusion</h3><p>We found that younger age and lower immediacy were associated with increased prescriptions of PIMs for older adults seen, while dementia and Northeastern rural region was associated with reduced use of PIMs seen and discharged from EDs in United States.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Nationwide Emergency Department Data Analysis to Predict Beers List Medications Use Among Older Adults\",\"authors\":\"Sangil Lee , Gabrielle Frediani , Brian C. Lund , Korey Kennelty , Molly Moore Jeffery , Ryan M. Carnahan\",\"doi\":\"10.1016/j.jemermed.2024.03.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The use of potentially inappropriate medications (PIMs) is considered an important quality indicator for older adults seen in the ambulatory care setting.</p></div><div><h3>Study Objectives</h3><p>To evaluate the pattern of potentially inappropriate medication (PIMs) use as specified in the Beers Criteria, for older adults during emergency department (ED) visits in the United States.</p></div><div><h3>Methods</h3><p>Using data from the National Hospital Ambulatory Care Survey (NHAMCS) we identified older adults (age 65 or older) discharged home from an ED visit in 2019. We defined PIMs as those with an ‘avoid’ recommendation under the American Geriatrics Society (AGS) 2019 Beers Criteria in older adults. Logistic regression models were used to assess demographic, clinical, and hospital factors associated with the use of any PIMs upon ED discharge.</p></div><div><h3>Results</h3><p>Overall, 5.9% of visits by older adults discharged from the ED included administration or prescriptions for PIMs. Among those who received any PIMs, 25.5% received benzodiazepines, 42.5 % received anticholinergics, 1.4% received nonbenzodiazepine hypnotics, and 0.5% received barbiturates. 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引用次数: 0
摘要
研究目的 评估美国老年人在急诊科(ED)就诊期间根据 Beers 标准使用潜在不适当药物(PIMs)的模式。方法 利用全国医院非住院医疗调查(NHAMCS)的数据,我们确定了 2019 年从急诊科出院回家的老年人(65 岁或以上)。根据美国老年医学会(AGS)2019 年老年人 Beers 标准,我们将 PIMs 定义为具有 "避免 "建议的 PIMs。我们使用逻辑回归模型来评估与急诊室出院时使用任何 PIMs 相关的人口、临床和医院因素。结果总体而言,5.9% 的急诊室出院老年人就诊时使用了 PIMs 或开具了 PIMs 处方。在使用任何 PIMs 的患者中,25.5% 使用了苯二氮卓类药物,42.5% 使用了抗胆碱能药物,1.4% 使用了非苯二氮卓类药物,0.5% 使用了巴比妥类药物。多变量模型显示,65 至 74 岁(OR 1.91,95% CI 1.39-2.62 vs. 年龄>=75)、痴呆(OR 0.45,95% CI 0.21-0.95)、低即时性(OR 2.45,95% CI 1.56-3.84 vs. 高即时性)和东北部农村地区(OR 0.34,95% CI 0.结论我们发现,在美国,较年轻的年龄和较低的即时性与老年人就诊的 PIMs 处方增加有关,而痴呆症和东北部农村地区与就诊和出院的 PIMs 使用减少有关。
A Nationwide Emergency Department Data Analysis to Predict Beers List Medications Use Among Older Adults
Background
The use of potentially inappropriate medications (PIMs) is considered an important quality indicator for older adults seen in the ambulatory care setting.
Study Objectives
To evaluate the pattern of potentially inappropriate medication (PIMs) use as specified in the Beers Criteria, for older adults during emergency department (ED) visits in the United States.
Methods
Using data from the National Hospital Ambulatory Care Survey (NHAMCS) we identified older adults (age 65 or older) discharged home from an ED visit in 2019. We defined PIMs as those with an ‘avoid’ recommendation under the American Geriatrics Society (AGS) 2019 Beers Criteria in older adults. Logistic regression models were used to assess demographic, clinical, and hospital factors associated with the use of any PIMs upon ED discharge.
Results
Overall, 5.9% of visits by older adults discharged from the ED included administration or prescriptions for PIMs. Among those who received any PIMs, 25.5% received benzodiazepines, 42.5 % received anticholinergics, 1.4% received nonbenzodiazepine hypnotics, and 0.5% received barbiturates. A multivariable model showed statistically significant associations for age 65 to 74 (OR 1.91, 95% CI 1.39–2.62 vs. age >=75), dementia (OR 0.45, 95% CI 0.21–0.95), lower immediacy (OR 2.45, 95% CI 1.56–3.84 vs. higher immediacy), and Northeastern rural region (OR 0.34, 95% CI 0.21–0.55 vs. Midwestern rural).
Conclusion
We found that younger age and lower immediacy were associated with increased prescriptions of PIMs for older adults seen, while dementia and Northeastern rural region was associated with reduced use of PIMs seen and discharged from EDs in United States.
期刊介绍:
The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections:
• Original Contributions
• Clinical Communications: Pediatric, Adult, OB/GYN
• Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care
• Techniques and Procedures
• Technical Tips
• Clinical Laboratory in Emergency Medicine
• Pharmacology in Emergency Medicine
• Case Presentations of the Harvard Emergency Medicine Residency
• Visual Diagnosis in Emergency Medicine
• Medical Classics
• Emergency Forum
• Editorial(s)
• Letters to the Editor
• Education
• Administration of Emergency Medicine
• International Emergency Medicine
• Computers in Emergency Medicine
• Violence: Recognition, Management, and Prevention
• Ethics
• Humanities and Medicine
• American Academy of Emergency Medicine
• AAEM Medical Student Forum
• Book and Other Media Reviews
• Calendar of Events
• Abstracts
• Trauma Reports
• Ultrasound in Emergency Medicine