Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Drugs & Aging
Published in: Drugs & Aging 8/2014

01-08-2014 | Original Research Article

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

Authors: Barbara Caecilia Wimmer, Elsa Dent, Renuka Visvanathan, Michael David Wiese, Kristina Johnell, Ian Chapman, J. Simon Bell

Published in: Drugs & Aging | Issue 8/2014

Login to get access

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.
Literature
1.
2.
3.
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.PubMedCrossRef
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.PubMedCentralPubMedCrossRef
6.
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.PubMedCrossRef
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.PubMedCrossRef
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.CrossRef
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.PubMedCrossRef
11.
Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5(4):345–51.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCentralPubMedCrossRef
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.PubMedCrossRef
18.
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.PubMedCrossRef
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.CrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
25.
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.PubMedCrossRef
27.
Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin Pharmacol Ther. 2009;85(1):86–8.PubMedCrossRef
28.
Fulton MM, Allen ER. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract. 2005;17(4):123–32.PubMedCrossRef
29.
Dierich MT, Mueller C, Westra BL. Medication regimens in older home care patients. J Gerontol Nurs. 2011;37(12):45–55.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCentralPubMedCrossRef
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.
36.
Witticke D, Seidling HM, Lohmann K, et al. Opportunities to reduce medication regimen complexity. Drug Saf. 2012;36(1):31–41.CrossRef
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
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
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.PubMedCrossRef
40.
Brown SH, Abdelhafiz AH. Institutionalization of older people: prediction and prevention. Aging Health. 2011;7(2):187–203.CrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCentralPubMedCrossRef
Metadata
Title
Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study
Authors
Barbara Caecilia Wimmer
Elsa Dent
Renuka Visvanathan
Michael David Wiese
Kristina Johnell
Ian Chapman
J. Simon Bell
Publication date
01-08-2014
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 8/2014
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.1007/s40266-014-0185-1

Other articles of this Issue 8/2014

Drugs & Aging 8/2014 Go to the issue

Original Research Article

A Meta-Synthesis of Potentially Inappropriate Prescribing in Older Patients

Erratum

Erratum to: Neuropsychiatric Symptoms in Patients with Dementias Associated with Cortical Lewy Bodies: Pathophysiology, Clinical Features, and Pharmacological Management

Adis Drug Evaluation

Rivastigmine Transdermal Patch 13.3 mg/24 h: A Review of Its Use in the Management of Mild to Moderate Alzheimer’s Dementia

Commentary

What Causes Some Patients with Drug-Induced QT Interval Prolongation to Develop Torsades de Pointes but Not Others? The Elusive Missing Link

Original Research Article

Determinants of Torsades de Pointes in Older Patients with Drug-Associated Long QT Syndrome: A Case-Control Study

Review Article

Vaccination in the Elderly: What Can Be Recommended?
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits