Inappropriate medication prescriptions in elderly adults surviving an intensive care unit hospitalization.
Open accessAbstract
Objectives: To determine types of potentially ( PIM s) and actually inappropriate medications ( AIM s), which PIM s are most likely to be considered AIM s, and risk factors for PIM s and AIM s at hospital discharge in elderly intensive care unit ( ICU ) survivors. Design: Prospective cohort study. Setting: Tertiary care, academic medical center. Participants: One hundred twenty individuals aged 60 and older who survived an ICU hospitalization. Measurements: Potentially inappropriate medications were defined according to published criteria; a multidisciplinary panel adjudicated AIM s. Medications from before admission, ward admission, ICU admission, ICU discharge, and hospital discharge were abstracted. Poisson regression was used to examine independent risk factors for hospital discharge PIM s and AIM s. Results: Of 250 PIM s prescribed at discharge, the most common were opioids (28%), anticholinergics (24%), antidepressants (12%), and drugs causing orthostasis (8%). The three most common AIM s were anticholinergics (37%), nonbenzodiazepine hypnotics (14%), and opioids (12%). Overall, 36% of discharge PIM s were classified as AIM s, but the percentage varied according to drug type. Whereas only 16% of opioids, 23% of antidepressants, and 10% of drugs causing orthostasis were classified as AIM s, 55% of anticholinergics, 71% of atypical antipyschotics, 67% of nonbenzodiazepine hypnotics and benzodiazepines, and 100% of muscle relaxants were deemed AIM s. The majority of PIM s and AIM s were first prescribed in the ICU . Preadmission PIM s, discharge to somewhere other than home, and discharge from a surgical service predicted number of discharge PIM s, but none of the factors predicted AIM s at discharge. Conclusion: Certain types of PIM s, which are commonly initiated in the ICU , are more frequently considered inappropriate upon clinical review. Efforts to reduce AIM s in elderly ICU survivors should target these specific classes of medications.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Hospitalization and ICU admission are high-risk periods for unintentional medication error, including continuations of medications for temporary indications and unintentional discontinuations of chronic medications.
“Hospitalization and ICU admission are high-risk periods for unintentional medication error-both continuations of medications for temporary indications and unintentional discontinuations of chronic medications (596, 599, 600, 602).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [596]
The Discussion reports that medications started for temporary indications in the ICU can remain prescribed at hospital discharge, supporting the continuation portion of the claim for elderly ICU survivors. It also explicitly says the study did not examine medication discontinuation, so it does not support the claim about unintentional discontinuation of chronic medications. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTransfer from ICU to general floor and discharge from the hospital are both vulnerable periods for patients, with high frequency of medication errors and information loss.
“Transfer from ICU to general floor and discharge from the hospital are both vulnerable periods for patients, with high frequency of medication errors and information loss (596-602).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [596]
The Discussion (page not provided) identifies ICU discharge and hospital discharge as points for reviewing medications, and reports that many inappropriate medications prescribed at discharge were first prescribed in the ICU. This supports concern about medication safety at both transitions in elderly ICU survivors, but the paper does not establish a high frequency of medication errors at each transition or address information loss. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHyperglycemia, hypoglycemia, and increased glycemic variability are associated with increased mortality in critically ill patients.
“Hyperglycemia (> 180mg/dL), hypoglycemia and increased glycemic variability are associated with increased mortality in critically ill patients (509-511).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [509]
The Methods and Results describe older ICU survivors studied for inappropriate medication prescriptions, and the Discussion addresses prescribing risks; no passage links blood-glucose levels to mortality. Searches for hyperglycemia, hypoglycemia, glycemic variability, and the 180 mg/dL threshold found no supporting passage in our copy. Page numbers were not available. (LLM, conf=0.77)
Experimental — accuracy not yet measuredHyperglycemia (> 180 mg/dL), hypoglycemia, and increased glycemic variability are associated with increased mortality in critically ill patients.
“Hyperglycemia (> 180mg/dL), hypoglycemia and increased glycemic variability are associated with increased mortality in critically ill patients (509-511).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [509]
The Methods (Study design and population) describe a cohort of critically ill patients, but the Results and Discussion address inappropriate medication prescriptions among older ICU survivors. Searches for hyperglycemia, hypoglycemia, glycemic variability, blood glucose, and mortality found no passage assessing the claimed associations; the shared ICU setting alone does not support them. (LLM, conf=0.76)
Experimental — accuracy not yet measuredTransfer from ICU to general floor and hospital discharge are vulnerable periods with high frequency of medication errors and information loss.
“Transfer from ICU to general floor and discharge from the hospital are both vulnerable periods for patients, with high frequency of medication errors and information loss [596–602].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [599]
Hospitalisation and ICU admission are high-risk periods for unintentional medication error, including continuations of temporary medications and discontinuations of chronic medications.
“Hospitalisation and ICU admission are high-risk periods for unintentional medication error—both continuations of medications for temporary indications and unintentional discontinuations of chronic medications [596, 599, 600, 602].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [599]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987) · Journal of Chronic Diseases · doi:10.1016/0021-9681(87)90171-8 · Cited by 49,742 · see citing works
Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1985) · Critical Care Medicine · doi:10.1097/00003246-198510000-00009 · Cited by 15,333 · see citing works
APACHE II-A Severity of Disease Classification System
Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1986) · Critical Care Medicine · doi:10.1097/00003246-198608000-00028 · Cited by 13,379 · see citing works
APACHE II: a severity of disease classification system.
Knaus, W. A., Draper, E. S., Wagner, D. P., & Zimmerman, J. E. (1985) · PubMed · Cited by 6,034 · see citing works
Ely, E. W., Inouye, S. K., Bernard, G. R., Gordon, S., Francis, J., May, L., Truman, B., Speroff, T., Gautam, S., Margolin, R., et al. (2001) · JAMA · doi:10.1001/jama.286.21.2703 · Cited by 3,210 · see citing works
Self-citationThe American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.03923.x · Cited by 2,578 · see citing works
Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., Maclean, J. R., & Beers, M. H. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.22.2716 · Cited by 2,389 · see citing works
Self-citationEmergency hospitalizations for adverse drug events in older Americans.
Budnitz, D., Lovegrove, M., Shehab, N., & Richards, C. (2011) · New England Journal of Medicine · doi:10.1056/nejmsa1103053 · Cited by 1,748 · see citing works
Schneider, L. S., Dagerman, K. S., & Insel, P. (2005) · JAMA · doi:10.1001/jama.294.15.1934 · Cited by 1,671 · see citing works
A method for assessing drug therapy appropriateness☆
Hanlon, J. T., Schmader, K. E., Samsa, G. P., Weinberger, M., Uttech, K. M., Lewis, I. K., Cohen, H. J., & Feussner, J. R. (1992) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(92)90144-c · Cited by 966 · see citing works
Risk of Death in Elderly Users of Conventional vs. Atypical Antipsychotic Medications
Wang, P. S., Schneeweiss, S., Avorn, J., Fischer, M. A., Mogun, H., Solomon, D. H., & Brookhart, M. A. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa052827 · Cited by 959 · see citing works
Clinical Pharmacists and Inpatient Medical Care
Kaboli, P. J., Hoth, A. B., McClimon, B. J., & Schnipper, J. L. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.9.955 · Cited by 881 · see citing works
The anticholinergic risk scale and anticholinergic adverse effects in older persons
Rudolph, J. L. (2008) · Archives of Internal Medicine · doi:10.1001/archinternmed.2007.106 · Cited by 835 · see citing works
Gallagher, P., & O’Mahony, D. (2008) · Age and Ageing · doi:10.1093/ageing/afn197 · Cited by 683 · see citing works
The State of Aging and Health in America 2007
(2007) · Aging Health · doi:10.2217/1745509x.3.2.139 · Cited by 649 · see citing works
Lau, D. T., Kasper, J. D., Potter, D. E. B., Lyles, A., & Bennett, R. G. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.1.68 · Cited by 442 · see citing works
Caring for the Critically Ill Patient
Angus, D. C. (2007) · JAMA · doi:10.1001/jama.298.4.456 · Cited by 345 · see citing works
Patel, R. P., Gambrell, M., Speroff, T., Scott, T. A., Pun, B. T., Okahashi, J., Strength, C., Pandharipande, P. P., Girard, T. D., Burgess, H., et al. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e31819b8608 · Cited by 319 · see citing works
Self-citationHealth outcomes associated with potentially inappropriate medication use in older adults
Fick, D. M., Mion, L. C., Beers, M. H., & Waller, J. L. (2007) · Research in Nursing & Health · doi:10.1002/nur.20232 · Cited by 291 · see citing works
Self-citationKesselheim, A. S., Cresswell, K., Phansalkar, S., Bates, D. W., & Sheikh, A. (2011) · Health Affairs · doi:10.1377/hlthaff.2010.1111 · Cited by 277 · see citing works
Bell, C. M., Brener, S. S., Gunraj, N., Huo, C., Bierman, A. S., Scales, D. C., Bajcar, J., Zwarenstein, M., & Urbach, D. R. (2011) · JAMA · doi:10.1001/jama.2011.1206 · Cited by 267 · see citing works
Unnecessary Drug Use in Frail Older People at Hospital Discharge
Hajjar, E. R., Hanlon, J. T., Sloane, R. J., Lindblad, C. I., Pieper, C. F., Ruby, C. M., Branch, L. G., & Schmader, K. E. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53523.x · Cited by 230 · see citing works
Inappropriate Medication Use and Health Outcomes in the Elderly
Fu, A. Z., Liu, G. G., & Christensen, D. B. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52522.x · Cited by 166 · see citing works
on behalf of investigators of the GIFA Study, Onder, G., Landi, F., et al. (2003) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-003-0600-8 · Cited by 130 · see citing works
Wright, R. M., Roumani, Y. F., Boudreau, R. M., Newman, A. B., Ruby, C. M., Studenski, S. A., Shorr, R. I., Bauer, D. C., Simonsick, E. M., Hilmer, S. N., et al. (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.02127.x · Cited by 128 · see citing works
Laroche, M., Charmes, J., Nouaille, Y., et al. (2006) · Drugs & Aging · doi:10.2165/00002512-200623010-00005 · Cited by 107 · see citing works
Lang, P.-O., Hasso, Y., Dramé, M., et al. (2010) · Age and Ageing · doi:10.1093/ageing/afq031 · Cited by 105 · see citing works
A national survey of the management of delirium in UK intensive care units
Sweeney, R. M., Barber, V. S., Page, V. J., Ely, E. W., Perkins, G. D., Young, D., & McAuley, D. F. (2010) · QJM · doi:10.1093/qjmed/hcp194 · Cited by 105 · see citing works
Self-citationPotentially inappropriate medication use in hospitalized elders
Rothberg, M. B., Pekow, P. S., Liu, F., Korc‐Grodzicki, B., Brennan, M. J., Bellantonio, S., Heelon, M. W., & Lindenauer, P. K. (2008) · Journal of Hospital Medicine · doi:10.1002/jhm.290 · Cited by 104 · see citing works
Simon, S. R., Smith, D. H., Feldstein, A. C., Perrin, N., Yang, X., Zhou, Y., Platt, R. G., & Soumerai, S. B. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00734.x · Cited by 100 · see citing works
Mattison, M. L. P. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.244 · Cited by 85 · see citing works
Inappropriate Medications in Elderly ICU Survivors: Where to Intervene?
Morandi, A. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.233 · Cited by 69 · see citing works
Self-citationPotentially inappropriate medication use in elderly patients
Harugeri, A., Joseph, J., Parthasarathi, G., et al. (2010) · Journal of Postgraduate Medicine · doi:10.4103/0022-3859.68642 · Cited by 67 · see citing works
MEDICATION APPROPRIATENESS INDEX: RELIABILITY AND RECOMMENDATIONS FOR FUTURE USE
Spinewine, A., Dumont, C., Mallet, L., et al. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00668_8.x · Cited by 61 · see citing works
Gizzi, L. A., Slain, D., Hare, J. T., Sager, R. B., Briggs, F., & Palmer, C. H. (2010) · The American Journal of Geriatric Pharmacotherapy · doi:10.1016/j.amjopharm.2010.03.004 · Cited by 32 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
Enhancing Recovery From Sepsis: A Review
Prescott, H. C., & Angus, D. C. (2018) · JAMA · doi:10.1001/jama.2017.17687 · Cited by 1,059 · see citing works
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082 · see citing works
Antipsychotic prescribing patterns during and after critical illness: A prospective cohort study.
Tomichek, J. E., Stollings, J. L., Pandharipande, P. P., Chandrasekhar, R., Ely, E. W., & Girard, T. D. (2016) · Critical Care · doi:10.1186/s13054-016-1557-1 · Cited by 100 · see citing works
Self-citationAssociation between Adherence to Recommended Care and Outcomes for Adult Survivors of Sepsis
Taylor, S. P., Chou, S.-H., Sierra, M. F., Shuman, T. P., McWilliams, A. D., Taylor, B. T., Russo, M., Evans, S. L., Rossman, W., Murphy, S., et al. (2020) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201907-514oc · Cited by 69 · see citing works
- Authors
- Morandi, A., Vasilevskis, E., Pandharipande, P. P., Girard, T. D., Solberg, L. M., Neal, E. B., Koestner, T., Torres, R. E., Thompson, J. L., Shintani, A. K., Han, J. H., Schnelle, J. F., Fick, D. M., Ely, E. W., & Kripalani, S.
- Affiliations
- Vanderbilt University (US)
- University of Tennessee Health Science Center (US)
- Pennsylvania State University (US)
- Corresponding author
- Morandi, Alessandro
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2013-07
- Volume
- 61
- Issue
- 7
- Pages
- 1128-1134
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC3713508
- OpenAlex
- W2044241529
- Cited by
- 126
- References
- 36
- Citations by year
- 2026: 12 · 2025: 2 · 2024: 7 · 2023: 6 · 2022: 12 · 2021: 10 · 2020: 14 · 2019: 14 · 2018: 13 · 2017: 10 · 2016: 6 · 2015: 10 · 2014: 9 · 2013: 1
- FWCI
- 4.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Clinical Science Research and Development
- National Institute on Aging (K23AG032355, AG034257, K23AG034257, AG027472, R01AG027472)
- National Institute of Nursing Research (R01NR011042)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- potentially inappropriate medications, intensive care unit hospitalization, hospital discharge, anticholinergic agents, opioids, non-benzodiazepine hypnotics, benzodiazepines, atypical antipsychotics, muscle relaxants, antidepressants, risk factors, medication review
- MeSH terms
- Aged, Female, Humans, Intensive Care Units, Male, Medication Errors, Middle Aged, Patient Discharge, Prospective Studies, Risk Factors, Severity of Illness Index, Comorbidity, Poisson Distribution, Survivors, APACHE, Polypharmacy, Inappropriate Prescribing
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
