{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T13:50:39Z","timestamp":1762869039753,"version":"3.32.0"},"reference-count":31,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T00:00:00Z","timestamp":1681171200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008810","name":"NSW Ministry of Health","doi-asserted-by":"publisher","award":["Translational Research Grant 274"],"award-info":[{"award-number":["Translational Research Grant 274"]}],"id":[{"id":"10.13039\/501100008810","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014467","name":"Western Sydney Local Health District","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014467","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brit J Clinical Pharma"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Comprehensively investigate prescribing in usual care of hospitalized older people with respect to polypharmacy; potentially inappropriate medications (PIMs) according to Beers criteria; and cumulative anticholinergic and sedative medication exposure calculated with Drug Burden Index (DBI). Specifically, to quantify exposure to these measures on admission, changes between admission and discharge, associations with adverse outcomes and medication costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Established new retrospective inpatient cohort of 2000 adults aged \u226575\u2009years, consecutively admitted to 6 hospitals in Sydney, Australia, with detailed information on medications, clinical characteristics and outcomes. Conducted cross\u2010sectional analyses of index admission data from cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Cohort had mean (standard deviation) age 86.0 (5.8) years, 59% female, 21% from residential aged care. On admission, prevalence of polypharmacy was 77%, PIMs 34% and DBI\u2009&gt;\u00a00 in 53%. From admission to discharge, mean difference (95% confidence interval) in total number of medications increased 1.05 (0.92, 1.18); while prevalence of exposure to PIMs (\u22123.8% [\u22125.4, \u22122.1]) and mean DBI score (\u22120.02 [\u22120.04, \u22120.01]) decreased. PIMs and DBI score were associated with increased risks (adjusted odds ratio [95% confidence interval]) of falls (PIMs 1.63 [1.28, 2.08]; DBI score 1.21[1.00, 1.46]) and delirium (PIMs 1.76 [1.38, 1.46]; DBI score 1.42 [1.19, 1.71]). Each measure was associated with increased risk of adverse drug reactions (polypharmacy 1.42 [1.19, 1.71]; PIMs 1.87 [1.40, 2.49]; DBI score 1.90 [1.55, 2.15]). Cost (AU$\/patient\/hospital day) of medications contributing to PIMs and DBI was low ($0.29 and $0.88).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this large cohort of older inpatients, usual hospital care results in an increase in number of medications and small reductions in PIMs and DBI, with variable associations with adverse outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.15727","type":"journal-article","created":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T06:00:39Z","timestamp":1680069639000},"page":"2508-2518","source":"Crossref","is-referenced-by-count":12,"title":["Towards Optimizing Hospitalized Older adults' MEdications (TO HOME): Multi\u2010centre study of medication use and outcomes in routine care"],"prefix":"10.1111","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5970-1501","authenticated-orcid":false,"given":"Sarah N.","family":"Hilmer","sequence":"first","affiliation":[{"name":"Kolling Institute The University of Sydney and Royal North Shore Hospital  St Leonards Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarita","family":"Lo","sequence":"additional","affiliation":[{"name":"Kolling Institute The University of Sydney and Royal North Shore Hospital  St Leonards Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health The University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosalie","family":"Viney","sequence":"additional","affiliation":[{"name":"Centre for Health Economics Research and Evaluation University of Technology  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiona M.","family":"Blyth","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health The University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David G.","family":"Le Couteur","sequence":"additional","affiliation":[{"name":"Centre for Education and Research on Ageing Concord Hospital and The University of Sydney  Concord Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"McLachlan","sequence":"additional","affiliation":[{"name":"Sydney Pharmacy School, Faculty of Medicine and Health The University of Sydney  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheena","family":"Arora","sequence":"additional","affiliation":[{"name":"Centre for Health Economics Research and Evaluation University of Technology  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lutfun","family":"Hossain","sequence":"additional","affiliation":[{"name":"Centre for Health Economics Research and Evaluation University of Technology  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9404-3401","authenticated-orcid":false,"given":"Danijela","family":"Gnjidic","sequence":"additional","affiliation":[{"name":"Sydney Pharmacy School, Faculty of Medicine and Health The University of Sydney  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,4,11]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Institute for Healthcare Improvement.Age\u2010friendly health systems: guide to using the 4Ms in the care of older adults.2020.https:\/\/www.ihi.org\/Engage\/Initiatives\/Age-Friendly-Health-Systems\/Documents\/IHIAgeFriendlyHealthSystems_GuidetoUsing4MsCare.pdf. 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