Identification of the Potential Pharmacotherapeutic Risk in Hospitalized Geriatric Patients

Geriatric patients need carefully tailored pharmacotherapeutic approaches to minimize the risks of inappropriate treatment and hospitalizations. In Slovakia, there is a lack of studies documenting the medication use patterns in hospitalized geriatric patients. The primary outcome of our study was to identify potential pharmacotherapeutic risks in hospitalized geriatric patients.

We performed a retrospective analysis of the medical records from 122 patients (65 years and older) hospitalized in the geriatric department. Potential pharmacotherapeutic risk was assessed by identifying potential drug-drug interactions (PDIs) and potentially inappropriate medications (PIMs). PDIs were identified using the Lexicomp® database, and PIMs were evaluated using the EU(7)-PIM list. PDIs were classified into five severity categories: A (unknown), B (minor), C (moderate), D (major), and X (contraindicated). Patients' medication was labeled as "PDIs in the therapy" or "PIMs in the therapy" based on the presence of PDIs or PIMs. If PDIs were identified, the patient was labeled "PDI in therapy"; if PIMs were found, the label "PIMs in the therapy" was applied.

Polypharmacy (61.5%, 75 patients) and hyperpolypharmacy (16.4%, 20 patients) were highly prevalent. PDIs were identified in 80.3% of patients (98 patients). Out of the total 417 PDIs, eight were contraindicated (type X) and 47 were classified as major (type D) interactions. PIMs were used by 73.8% of patients (90 patients), with the most common being pantoprazole (37.7%, 46 patients), alprazolam (27.8%, 34 patients), and digoxin (15.6%, 19 patients). We found a moderate relationship between the number of used drugs and the number of PIMs (ρ = 0.574, R² = 0.8697, p < 0.001). The mean number of hospitalizations was higher in patients with PDI in therapy (p < 0.001), had a weak relationship with the number of PDIs (p < 0.05), and did not correlate with the number of used drugs or PIMs. Only 6.6% of patients (eight patients) had no potential pharmacotherapeutic risk, while 32% (39 patients) had mild risk (PDIs or PIMs), and 61.5% (75 patients) had high risk (both PDIs and PIMs in the therapy).

Our results underscore the urgent need for medication reviews by hospital pharmacists and the active promotion of drug deprescription among clinicians.