The impact of inappropriate medication and pressure ulcer on hospital outcomes among geriatric patients with critical illnesses: A prospective cohort study

Abstract

<b>Background:</b> Nowadays, global aging is phenomenal and drawing attention towards novel health perspectives. Geriatric syndromes have a crucial, but under-studied influence on critical care outcomes. This study aimed to assess the impact of potentially inappropriate medication (PIM) and pressure ulcer (PU) on hospital outcomes among geriatric patients with critical illnesses.<br /> <b>Methods:</b> A prospective cohort study included 203 geriatric patients with critical illnesses at Ain Shams University geriatrics hospital. The 3<sup>rd</sup> version of the screening tool of older persons’ prescriptions criteria and the 4<sup>th </sup>edition of international PU guidelines were implemented to define PIM and PU, respectively. A thorough clinical assessment was carried out. Comorbidity, demographic, and laboratory profiles were gathered upon admission. The age-adjusted Charlson comorbidity index measured multimorbidity. Patients were observed for mortality as the sequel hospital outcome. Statistical analyses were executed.<br /> <b>Results:</b> Mean age was 75.00 ± 7.42 years. The most prevalent PU were of the second stage (40.4%) and sacrococcygeal site (26.7%). While the most frequent PIM were anticholinergics (51.30%) and opioids (27.60%). In-hospital mortality rate was 74.9%. Factors independently associated with mortality included serum albumin (odds ratio [OR] = .251, p =0.001, 95% confidence interval [CI] = 0.111-0.565) and the number of PIM (OR = 1.302, p = 0.037, 95% CI = 1.016-1.667). Use of > 1.5 PIM predicted mortality with 63.4% sensitivity and 51.7% specificity with an area under the receiver operating characteristic curve of 0.640, p = 0.005.<br /> <b>Conclusion:</b> The study underscores the deleterious impact of PIM and PU as pervasive age-related conditions during critical illness. The number of PIM and serum albumin are independently associated with hospital mortality. However, the involvement of a restricted number of participants from a selected geriatrics hospital in Egypt limits the generalization of the findings and warrants further longitudinal research and external validation. Pertinent medication reconciliation and periodic skin evaluation should be routinely integrated within a holistic solicitation towards geriatric patients with critical illnesses.