**2. Objectives**

To analyze the inappropriate prescription and quality of life of hospitalized elderly according to internationally validated instruments.

## **3. Materials and methods**

Retrospective observational study. The patients included were adults over 64 years hospitalized in the study center. The study was carried out in a highly complex academic hospital in Argentina. The criteria of Screening Tool of Older Person's Prescriptions (STOPP) 2015, [6] of inappropriate prescription of drugs, were used. Polypharmacy was considered to be the simultaneous presence of more than 4 drugs according to the WHO definition [7]. The investigators who analyzed the inappropriate prescriptions were two observers trained in the criteria, both of whom reviewed all cases. Concordance between the two reviewers was assessed with Cohen's Kappa test, obtaining a value of: 0.71 (95% CI 0.65–0.76). The burden of disease was assessed with the Charlson index [8], which predicts mortality and burden of disease according to preceding pathologies. The EURO-QOL 5d [9] scale was used to assess the perception of quality of life that contains 5 dimensions or topics: mobility, personal care, daily activities, pain/ discomfort, anxiety /depression. These topics have three options: - mild, −moderate and -high presence of each topic analyzed. The survey was done in person before discharge and to facilitate the analysis of the results, the questions were divided into three topics: "no problems", "moderate problems", and "serious or serious problems" (coinciding with the three options of each topical). Variables such as sex, age, family life, active patient with current job or in retirement, smoking habit, polypharmacy, among others, were collected. The data were loaded into Excel databases and processed with the SPSS 21 package, IBM®.

### **4. Results**

300 hospitalized patients were studied in the 2016–2018 year. The distribution by sex was: 169 (56.4%) women and 131 (43.6%) men. The mean age was 73.3 + 18.5 years. Median: 69.12.

In the total sample analyzed, 16% (n = 48) showed inappropriate prescription of drugs criteria.

The types of drugs most involved were the following **Table 1**.

The mean well-being of the patients on the scale of 1–100 was 56.8 (SD 23.4), median: 61.7, range: 29–95.

The quality of life scale showed the following **Table 2**.

Of the 300 patients, 143 (47.7%) lived with their family (spouse, children, nephews, grandchildren, etc.), 81 (27%) lived alone or with a non-family caregiver, 76 (25.3%) lived in geriatric.

In an unadjusted multiple binary regression, the association of different variables with the perception of quality of life was the one shown in the following table (**Tables 3** and **4**).

**153**

**5. Discussion**

**Table 4.**

*Inappropriate Medication and Perception of Quality of Life in Hospitalized Elderly Patients*

**Therapeutical Groups N Percentage (IC95%)** Non esteroidal pain relievers 21 43,8 (43,5-44,1) Oral anticoagulants 16 33,3 (32,9-33,6) Psychopfarmaceuticals 9 18,7 (18,2-18,9) Others 2 4,2 (4,1-4,7)

**Global perception of quality of life N Percentage (IC95%)** Without problems 123 41 (40,9-42,3) With moderate problems 98 32,7 (32,3-32,9) With serious problems 79 26,3 (26,1-26,8)

**PIM**

**Variable OR (IC 95%)** Inappropriate precsription 1,52 (1,37-2,16) Active work 1,76(1,16-1,97) Life in a nursing home 1,89(1,45-2,15) Female sex 1,98(1,35-2,13) Polypharmacy 1,11(0,76-1,89) Age over 80 years 1,13(0,98-2,14) Severe–moderate pain 1,21(0,96-1,69) Severe–moderate depression 1,23(0,97-1,34)

*Binary multiple regression of different variables with perception of quality of life.*

Without problems 16 (20,25%) 107 (79,75%) 0,001 With moderate problems 38 (38,8%) 60 (61,2%) 0,005 With serius problems 56 (70,8%) 23 (29,2%) 0,002

**Without PIM p Value**

Overall inappropriate prescribing values are similar by some studies [10, 11]. It is important to note that this study demonstrated a strong association between

inappropriate medication with positive STOPP criteria and the perception of

*DOI: http://dx.doi.org/10.5772/intechopen.95499*

**Table 1.**

**Table 2.**

**Table 3.**

*Frequencies by drug type.*

*The quality of life scale showed the following.*

**Variable With**

*Quality of life scales with and without inapprorpiate prescription.*

*Inappropriate Medication and Perception of Quality of Life in Hospitalized Elderly Patients DOI: http://dx.doi.org/10.5772/intechopen.95499*


#### **Table 1.**

*Update in Geriatrics*

**2. Objectives**

65 years of age is explored.

**3. Materials and methods**

exists between inappropriate medication and welfare states in the population over

To analyze the inappropriate prescription and quality of life of hospitalized

Retrospective observational study. The patients included were adults over 64 years hospitalized in the study center. The study was carried out in a highly complex academic hospital in Argentina. The criteria of Screening Tool of Older Person's Prescriptions (STOPP) 2015, [6] of inappropriate prescription of drugs, were used. Polypharmacy was considered to be the simultaneous presence of more than 4 drugs according to the WHO definition [7]. The investigators who analyzed the inappropriate prescriptions were two observers trained in the criteria, both of whom reviewed all cases. Concordance between the two reviewers was assessed with Cohen's Kappa test, obtaining a value of: 0.71 (95% CI 0.65–0.76). The burden of disease was assessed with the Charlson index [8], which predicts mortality and burden of disease according to preceding pathologies. The EURO-QOL 5d [9] scale was used to assess the perception of quality of life that contains 5 dimensions or topics: mobility, personal care, daily activities, pain/ discomfort, anxiety /depression. These topics have three options: - mild, −moderate and -high presence of each topic analyzed. The survey was done in person before discharge and to facilitate the analysis of the results, the questions were divided into three topics: "no problems", "moderate problems", and "serious or serious problems" (coinciding with the three options of each topical). Variables such as sex, age, family life, active patient with current job or in retirement, smoking habit, polypharmacy, among others, were collected. The data were loaded into Excel databases and processed with the SPSS 21 package, IBM®.

300 hospitalized patients were studied in the 2016–2018 year. The distribution by sex was: 169 (56.4%) women and 131 (43.6%) men. The mean age was

The types of drugs most involved were the following **Table 1**.

The quality of life scale showed the following **Table 2**.

In the total sample analyzed, 16% (n = 48) showed inappropriate prescription of

The mean well-being of the patients on the scale of 1–100 was 56.8 (SD 23.4),

Of the 300 patients, 143 (47.7%) lived with their family (spouse, children, nephews, grandchildren, etc.), 81 (27%) lived alone or with a non-family caregiver,

In an unadjusted multiple binary regression, the association of different variables with the perception of quality of life was the one shown in the following table

elderly according to internationally validated instruments.

**152**

**4. Results**

drugs criteria.

73.3 + 18.5 years. Median: 69.12.

median: 61.7, range: 29–95.

76 (25.3%) lived in geriatric.

(**Tables 3** and **4**).

*Frequencies by drug type.*


#### **Table 2.**

*The quality of life scale showed the following.*


#### **Table 3.**

*Quality of life scales with and without inapprorpiate prescription.*


#### **Table 4.**

*Binary multiple regression of different variables with perception of quality of life.*

## **5. Discussion**

Overall inappropriate prescribing values are similar by some studies [10, 11]. It is important to note that this study demonstrated a strong association between inappropriate medication with positive STOPP criteria and the perception of

a deterioration in quality of life, because a person who receives inappropriate medication increases 2.3 times the chance of perceiving a deterioration in their quality of life.

A systematic review found that the drugs most exclusively included in the inappropriate prescription were non-steroidal anti-inflammatory drugs and benzodiazepines [12]. The review of Mahony [12], it states that the application of the STOPP criteria improves clinical outcomes in multimorbid older people but does not mention the impact it has on quality of life.

Furthermore, it is possible to affirm that there is a relationship between the inappropriate prescription of medication and polypharmacy, female sex, age over 80 years, presence of comorbidities such as pain, anxiety and/or depression.

We have not found studies of quality of life and inappropriate medication. It is important to link the states of well-being with the inappropriate use of medications to know other impacts on the public health of this population segment.
