Patient-Related Factors Associated With the Initiation of Potentially Inappropriate Medication in Home Care: An Observational Study Based on Resident Assessment Instrument Data

Background: The harmful outcomes of potentially inappropriate medications (PIMs) are highlighted among multimorbid older home care clients using several medicines. The aim of this study was to identify patient-related factors associated with the initiation of PIMs.

Methods: This register-based study used Resident Assessment Instrument-Home Care (RAI-HC) assessments (n = 6176) from year 2014 to 2015. PIMs were identified according to the Beers criteria. Generalised estimating equations were used to identify factors associated with the initiation of PIMs.

Findings: A total of 228 (11.3%) clients initiated PIMs during the follow-up (mean 13 months). Factors associated with higher odds to initiate PIMs were higher education (OR = 1.36, 95% CI 1.02-1.82), cognitive impairment (OR = 1.70, 1.02-2.82), reduced social interaction (OR = 1.50, 1.06-2.13), independent activity outdoors (OR = 1.72, 1.18-2.51), diabetes (OR = 1.47, 1.12-1.94), Parkinson's disease (OR = 3.42, 1.86-6.27) and longer interval between RAI assessments (OR = 1.09 per month, 1.02-1.18).

Conclusions: Incidence of PIMs among home care clients was common. The results help healthcare professionals to focus more attention on clients more susceptible to PIM prescribing. Preventing PIM use is essential, especially among older adults with cognitive impairment, to prevent further decline of health status and admission to long-term care.