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Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study

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Abstract

Background

Older people often take multiple medications. It is a policy priority to facilitate older people to stay at home longer. Three-quarters of nursing home placements in the US are preceded by a hospitalization.

Objective

To investigate the association between polypharmacy and medication regimen complexity with hospital discharge destination among older people.

Methods

This prospective cohort study comprised patients aged ≥70 years consecutively admitted to the Geriatric Evaluation and Management unit at a tertiary hospital in Adelaide, Australia, between October 2010 and December 2011. Medication regimen complexity at discharge was calculated using the 65-item validated Medication Regimen Complexity Index (MRCI). Unadjusted and adjusted relative risks (RRs) with 95 % confidence intervals (CIs) were calculated for medication-related factors associated with discharge directly to home versus non-community settings (rehabilitation, transition care, and residential aged care).

Results

From 163 eligible patients, 87 were discharged directly to home (mean age 84.6 years, standard deviation [SD] 6.9; mean MRCI 26.1, SD 9.7), while 76 were discharged to non-community settings (mean age 85.8 years, SD 5.8; mean MRCI 29.9, SD 13.2). After adjusting for age, sex, comorbidity, and activities of daily living, having a high medication regimen complexity (MRCI >35) was inversely associated with discharge directly to home (RR 0.39; 95 % CI 0.20–0.73), whereas polypharmacy (≥9 medications) was not significantly associated with discharge directly to home (RR 0.97; 95 % CI 0.53–1.58).

Conclusion

Having high medication regimen complexity was inversely associated with discharge directly to home, while polypharmacy was not associated with discharge destination.

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References

  1. World Health Organization. Active ageing: a policy framework. Geneva. 2002. Available from: http://whqlibdoc.who.int/hq/2002/who_nmh_nph_02.8.pdf. Accessed 17 Sep 2013.

  2. Australian Government Department of Health and Ageing. Living longer. Living better. 2012. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-aged-care-review-measures-living.htm. Accessed 1 Nov 2013.

  3. US Department of Health and Human Services. Centers for Disease Control and Prevention. National hospital discharge survey. 2010. Available from: ftp://cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHDS/NHDS_2010_Documentation.pdf. Accessed 20 Sep 2013.

  4. Goodwin JS, Howrey B, Zhang DD, et al. Risk of continued institutionalization after hospitalization in older adults. J Gerontol A Biol Sci Med Sci. 2011;66(12):1321–7.

    Article  PubMed  Google Scholar 

  5. Jarman B, Aylin P, Bottle A. Discharge destination and length of stay: differences between US and English hospitals for people aged 65 and over. BMJ. 2004;328(7440):605.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Karmel R, Hales C, Lloyd J. Older Australians in hospital. AIHW bulletin no. 53. Cat. no. AUS 92. Canberra: AIHW; 2007. Available from: http://www.aihw.gov.au/publication-detail/?id=6442468020. Accessed 18 Sep 2013.

  7. Rudberg MA, Sager MA, Zhang J. Risk factors for nursing home use after hospitalization for medical illness. J Gerontol A Biol Sci Med Sci. 1996;51(5):M189–94.

    Article  CAS  PubMed  Google Scholar 

  8. Van Craen K, Braes T, Wellens N, et al. The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis. J Am Geriatr Soc. 2010;58(1):83–92.

    Article  PubMed  Google Scholar 

  9. Heppenstall CP, Keeling S, Hanger HC, et al. Perceived factors which shape decision-making around the time of residential care admission in older adults: a qualitative study. Aust J Ageing. 2014;33(1):9–13.

    Article  Google Scholar 

  10. Budnitz DS, Lovegrove MC, Shehab N, et al. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365(21):2002–12.

    Article  CAS  PubMed  Google Scholar 

  11. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5(4):345–51.

    Article  PubMed  Google Scholar 

  12. Hanlon JT, Schmader KE, Ruby CM, et al. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc. 2001;49(2):200–9.

    Article  CAS  PubMed  Google Scholar 

  13. Hajjar ER, Hanlon JT, Sloane RJ, et al. Unnecessary drug use in frail older people at hospital discharge. J Am Geriatr Soc. 2005;53(9):1518–23.

    Article  PubMed  Google Scholar 

  14. Mansur N, Weiss A, Beloosesky Y. Looking beyond polypharmacy: quantification of medication regimen complexity in the elderly. Am J Geriatr Pharmacother. 2012;10(4):223–9.

    Article  PubMed  Google Scholar 

  15. Harris CM, Sridharan A, Landis R, et al. What happens to the medication regimens of older adults during and after an acute hospitalization? J Patient Saf. 2013;9(3):150–3.

    Article  PubMed  Google Scholar 

  16. Elliott RA, Ross-Degnan D, Adams AS, et al. Strategies for coping in a complex world: adherence behavior among older adults with chronic illness. J Gen Intern Med. 2007;22(6):805–10.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Dent E, Visvanathan R, Piantadosi C, et al. Use of the mini nutritional assessment to detect frailty in hospitalised older people. J Nutr Health Aging. 2012;16(9):764–7.

    Article  CAS  PubMed  Google Scholar 

  18. World Health Organization. Guidelines for ATC classification and DDD assignment. 2012. Available from: http://www.whocc.no/atc_ddd_index/. Accessed 17 Sept 2013.

  19. George J, Phun YT, Bailey MJ, et al. Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004;38(9):1369–76.

    Article  PubMed  Google Scholar 

  20. Libby AM, Fish DN, Hosokawa PW, et al. Patient-level medication regimen complexity across populations with chronic disease. Clin Ther. 2013;35(4):385–98.e1.

  21. Rettig SM, Wood Y, Hirsch JD. Medication regimen complexity in patients with uncontrolled hypertension and/or diabetes. J Am Pharm Assoc. 2013;53(4):427–31.

    Article  Google Scholar 

  22. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  CAS  PubMed  Google Scholar 

  23. Beloosesky Y, Weiss A, Mansur N. Validity of the medication-based Disease Burden Index compared with the Charlson Comorbidity Index and the Cumulative Illness Rating Scale for geriatrics: a cohort study. Drugs Aging. 2011;28(12):1007–14.

    Article  PubMed  Google Scholar 

  24. Hartigan I. A comparative review of the Katz ADL and the Barthel Index in assessing the activities of daily living of older people. Int J Older People Nurs. 2007;2(3):204–12.

    Article  PubMed  Google Scholar 

  25. Zhang J, Kai FY. What’s the relative risk? JAMA. 1998;280(19):1690–1.

    Article  CAS  PubMed  Google Scholar 

  26. Luppa M, Luck T, Weyerer S, et al. Prediction of institutionalization in the elderly: a systematic review. Age Ageing. 2010;39(1):31–8.

    Article  PubMed  Google Scholar 

  27. Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin Pharmacol Ther. 2009;85(1):86–8.

    Article  CAS  PubMed  Google Scholar 

  28. Fulton MM, Allen ER. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract. 2005;17(4):123–32.

    Article  PubMed  Google Scholar 

  29. Dierich MT, Mueller C, Westra BL. Medication regimens in older home care patients. J Gerontol Nurs. 2011;37(12):45–55.

    Article  PubMed  Google Scholar 

  30. Fröhlich SE, Zaccolo AV, da Silva SLC, et al. Association between drug prescribing and quality of life in primary care. Pharm World Sci. 2010;32(6):744–51.

    Article  PubMed  Google Scholar 

  31. Mansur N, Weiss A, Beloosesky Y. Relationship of in-hospital medication modifications of elderly patients to postdischarge medications, adherence, and mortality. Ann Pharmacother. 2008;42(6):783–9.

    Article  PubMed  Google Scholar 

  32. Betteridge TM, Frampton CM, Jardine DL. Polypharmacy—we make it worse! A cross-sectional study from an acute admissions unit. Intern Med J. 2012;42(2):208–11.

    Article  CAS  PubMed  Google Scholar 

  33. Saad M, Harisingani R, Katinas L. Impact of geriatric consultation on the number of medications in hospitalized older patients. Consult Pharm. 2012;27(1):42–8.

    Article  PubMed  Google Scholar 

  34. Corsonello A, Pedone C, Corica F, et al. Polypharmacy in elderly patients at discharge from the acute care hospital. Ther Clin Risk Manag. 2007;3(1):197–203.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Elliott RA, O’Callaghan CJ. Impact of hospitalisation on the complexity of older patients’ medication regimens and potential for regimen simplification. J Pharm Pract Res. 2011;41:21–5.

    Google Scholar 

  36. Witticke D, Seidling HM, Lohmann K, et al. Opportunities to reduce medication regimen complexity. Drug Saf. 2012;36(1):31–41.

    Article  Google Scholar 

  37. Hope CJ, Wu J, Tu W, et al. Association of medication adherence, knowledge, and skills with emergency department visits by adults 50 years or older with congestive heart failure. Am J Health Syst Pharm. 2004;61(19):2043–9.

    PubMed  Google Scholar 

  38. Stange D, Kriston L, von-Wolff A, et al. Reducing cardiovascular medication complexity in a German university hospital: effects of a structured pharmaceutical management intervention on adherence. J Manag Care Pharm. 2013;19(5):396–407.

    PubMed  Google Scholar 

  39. Gnjidic D, Hilmer SN, Blyth FM, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989–95.

    Article  PubMed  Google Scholar 

  40. Brown SH, Abdelhafiz AH. Institutionalization of older people: prediction and prevention. Aging Health. 2011;7(2):187–203.

    Article  Google Scholar 

  41. Campbell SE, Seymour DG, Primrose WR, et al. A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing. 2004;33(2):110–5.

    Article  PubMed  Google Scholar 

  42. Meyer C, Stern M, Woolley W, et al. How reliable are patient-completed medication reconciliation forms compared with pharmacy lists? Am J Emerg Med. 2011;30:1048–54.

    Article  PubMed  Google Scholar 

  43. Bell JS, Johnell K, Wimmer BC, et al. Multidose drug dispensing and optimising drug use in older people. Age Ageing. 2013;42(5):556–8.

    Article  PubMed  Google Scholar 

  44. Lau HS, Florax C, Porsius AJ, et al. The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol. 2000;49(6):597–603.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

No external sources of funding were used for this study. Barbara C. Wimmer received an International President’s Scholarship from the University of South Australia to undertake the research reported in this manuscript. Barbara C. Wimmer, Elsa Dent, Renuka Visvanathan, Michael D. Wiese, Kristina Johnell, Ian Champan, and J. Simon Bell have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia

    Barbara Caecilia Wimmer, Michael David Wiese & J. Simon Bell

  2. Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia

    Barbara Caecilia Wimmer & J. Simon Bell

  3. Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia

    Elsa Dent, Renuka Visvanathan & Ian Chapman

  4. Discipline of Public Health, University of Adelaide, Adelaide, SA, Australia

    Elsa Dent

  5. Aged and Extended Care Services, The Queen Elizabeth Hospital and the Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, University of Adelaide, Adelaide, SA, Australia

    Renuka Visvanathan

  6. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden

    Kristina Johnell

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  1. Barbara Caecilia Wimmer
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  2. Elsa Dent
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  3. Renuka Visvanathan
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  4. Michael David Wiese
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  7. J. Simon Bell
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Correspondence to Barbara Caecilia Wimmer.

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Wimmer, B.C., Dent, E., Visvanathan, R. et al. Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study. Drugs Aging 31, 623–630 (2014). https://doi.org/10.1007/s40266-014-0185-1

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