Potentially inappropriate prescription and its association with index hospitalization: a multicenter, cross-sectional study using TIME criteria

Abstract

Background and Objective: To evaluate the prevalence and types of potentially inappropriate prescriptions (PIP) in hospitalized older adults and to study whether PIP was a causative factor for index hospitalization, using the Turkish Inappropriate Medication Use in oldEr adults (TIME) criteria. Methods: This multicenter, cross-sectional study included 405 inpatients aged ≥60 years from 13 tertiary hospital departments in Turkiye between January 2020 and April 2021. PIP were assessed using TIME criteria, which include both potentially inappropriate medications, PIM (TIME-to-STOP) and potential prescribing omissions, PPO (TIME-to-START). Following the completion of medical history taking, physical examination, and comprehensive geriatric assessment (CGA), managing physicians evaluated each criterion individually. Based on clinical adjudication, they determined whether any PIM or PPO predefined in the TIME criteria could plausibly have contributed to the hospitalization. Results: The prevalence of PIP was 82.5%, with 63.2% of patients meeting at least one TIME-to-STOP and 71.6% meeting one TIME-to-START criterion. The top-three most common PIM identified via TIME-to-STOP criteria were: Long-term proton pump inhibitor (PPI) use without indication with 7.2%, PPI use for uncomplicated peptic ulcer disease, or erosive peptic esophagitis at full therapeutic dose for > 8–12 weeks with 3.0%, and diuretic use as first-line treatment of essential hypertension with concurrent urinary incontinence with 3.0%. The top-three most common PPO identified via TIME-to-START criteria were: Herpes zoster vaccination with 73.6%, Seasonal influenza vaccination annually with 59.3%, and Pneumococcal vaccination after age 65 with 57.3%. Among all participants, 34.1% had PIP causally related to hospitalization. Overtreatment of hypertension in patients with frailty was the most common PIM-related hospitalization factor (2.5%). Lack of oral nutritional supplements in patients with malnutrition was the leading PPO linked to hospitalization (11.6%). Conclusions: PIP were highly prevalent in hospitalized older adults and frequently contributed to hospital admission. TIME criteria provided a comprehensive and context-adapted tool for identifying both inappropriate medication use and missed treatment opportunities. Routine implementation of TIME criteria-guided medication reviews may represent a promising strategy to enhance medication safety and reduce avoidable hospitalizations in older populations, warranting further investigation.