(129) Older US adults refilling potentially inappropriate medications after hip fracture

Background: Recurrent falls and injuries are common among patients with hip fracture, and appropriate medication use is critical to improve patient outcomes. Although the Screening Tool of Older Persons’ Prescriptions (STOPP) Criteria suggest stopping certain medications to prevent falls in older adults, compliance with these recommendations is unknown.

Objectives: To estimate the proportion of inappropriate medication refills after hip fracture among older US adults and investigate predictors of inappropriate refilling.

Methods: We assembled a cohort of fee-for-service Medicare beneficiaries aged ≥66 years who were hospitalized for a hip fracture and discharged home between January 1, 2008 and September 30, 2017. For inclusion in our study, we required patients to have prior 12-month Medicare Part A, B, and D coverage and a prescription dispensed for a drug class listed in the STOPP criteria (benzodiazepines, neuroleptic drugs, hypnotic Z-drugs, antiepileptic drugs, opioids, antidepressants, alpha-blockers, centrally acting antihypertensives, antimuscarinics, or first-generation antihistamines) in the 3 months prior to the hospital admission. We calculated the proportion and corresponding 95% confidence interval (CI) of patients who refilled a STOPP drug during the 3 months after discharge overall and by drug class and used logistic regression to identify baseline characteristics associated with refilling a STOPP drug.

Results: Among the 6,639 patients (mean age 78±6 years old) included in our study, 76% were female, 90% were non-Hispanic White, 38% were eligible for the Medicare low-income subsidy, and 31% had dementia. The median baseline Gagne Comorbidity Index was 4 (interquartile range: 2–6). Before hospitalization, 56% of patients had a dispensed prescription for opioids, 48% had antidepressants, and 21% had antiepileptic drugs. After discharge, 92% (95% CI: [91%, 93%]) of patients refilled at least one STOPP drug. 87% (95% CI: [86%, 88%]) of patients on opioids, 81% (95% CI: [80%, 83%]) of patients on antidepressants, and 76% (95% CI: [74%, 79%]) of patients on antiepileptic drugs refilled medications. Women (OR=1.6, 95% CI: [1.3, 1.9]), patients without dementia (OR=1.5, 95% CI: [1.1, 1.9]), and younger patients (10-year OR=0.6, 95% CI: [0.5, 0.7]) were more likely to refill a STOPP drug.

Conclusions: The proportion of potentially inappropriate medication refills after hospitalization for a hip fracture is high among older adults in the US. Further research is needed to identify additional factors influencing refilling behavior and strategies to optimize medication management among older adults after hip fracture.