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Background <p>In an ageing population, drug-related problems, including potentially inappropriate medications (PIMs), are increasingly relevant. PIM lists are important tools for improving medication safety in older adults.</p> Objective <p>As part of the POLAR_MI (POLypharmacy, drug interActions, Risks) project, this study aimed to assess the prevalence of PIM and its association with falls in patients aged ≥&#xa0;65 years, based on the methods and processes of the Medical Informatics Initiative Germany.</p> Methods <p>A retrospective, distributed analysis of electronic health records (EHRs) (2018–2021) was conducted at ten German university hospitals. PIMs were defined using PRISCUS and EU(7)-PIM lists. Falls were identified using documented fractures as a surrogate. Multivariable logistic regression modelling was applied, adjusting for confounders including age, gender, Charlson Comorbidity Index (CCI) and fall-risk-increasing drugs (FRIDs).</p> Results <p>A total of 166,126 cases (median age: 76 years; 45.8% women) were analysed. According to PRISCUS, 12.8% of cases had at least one PIM, with amitriptyline most common (1.1% of all cases). According to EU(7)-PIM, 45.6% of cases were affected, with apixaban most frequent (8.6%). An association between falls and at least one PIM (PRISCUS: adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 0.94–1.55; EU(7)-PIM: aOR 1.01, 95% CI 0.83–1.22) could not be observed. However, FRIDs were associated with falls (PRISCUS: aOR 2.31, 95% CI 1.64–3.27; EU(7)-PIM: aOR 2.43, 95% CI 1.69–3.48).</p> Conclusions <p>In this large multicentre EHR analysis, PIMs were common in older patients, but an association with an increased likelihood of falls could not be observed. In contrast, the well-known association with FRIDs was confirmed. The ongoing digitalisation of German hospitals enables such large-scale data analyses for risk assessment and supports improvements in patient safety.</p>

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Use of Potentially Inappropriate Medication and Association with Falls During Hospitalisation: An Analysis Based on Electronic Health Records (POLAR_MI project)

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月19日

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  • Louisa Redeker,
  • Miriam Kesselmeier,
  • Beate Mussawy,
  • Steffen Grabe,
  • Marietta Rottenkolber,
  • Torsten Thalheim,
  • Florian Schmidt,
  • Thomas Peschel,
  • Alexander Strübing,
  • Daniel Neumann,
  • André Scherag,
  • Markus Loeffler,
  • Sven Schmiedl,
  • Petra Thürmann

摘要

Background

In an ageing population, drug-related problems, including potentially inappropriate medications (PIMs), are increasingly relevant. PIM lists are important tools for improving medication safety in older adults.

Objective

As part of the POLAR_MI (POLypharmacy, drug interActions, Risks) project, this study aimed to assess the prevalence of PIM and its association with falls in patients aged ≥ 65 years, based on the methods and processes of the Medical Informatics Initiative Germany.

Methods

A retrospective, distributed analysis of electronic health records (EHRs) (2018–2021) was conducted at ten German university hospitals. PIMs were defined using PRISCUS and EU(7)-PIM lists. Falls were identified using documented fractures as a surrogate. Multivariable logistic regression modelling was applied, adjusting for confounders including age, gender, Charlson Comorbidity Index (CCI) and fall-risk-increasing drugs (FRIDs).

Results

A total of 166,126 cases (median age: 76 years; 45.8% women) were analysed. According to PRISCUS, 12.8% of cases had at least one PIM, with amitriptyline most common (1.1% of all cases). According to EU(7)-PIM, 45.6% of cases were affected, with apixaban most frequent (8.6%). An association between falls and at least one PIM (PRISCUS: adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 0.94–1.55; EU(7)-PIM: aOR 1.01, 95% CI 0.83–1.22) could not be observed. However, FRIDs were associated with falls (PRISCUS: aOR 2.31, 95% CI 1.64–3.27; EU(7)-PIM: aOR 2.43, 95% CI 1.69–3.48).

Conclusions

In this large multicentre EHR analysis, PIMs were common in older patients, but an association with an increased likelihood of falls could not be observed. In contrast, the well-known association with FRIDs was confirmed. The ongoing digitalisation of German hospitals enables such large-scale data analyses for risk assessment and supports improvements in patient safety.