Polypharmacy and Hospitalization Among Older Home Care Patients

Division of Geriatric Medicine, Saint Louis University Medical School, Missouri 63104, USA.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences (Impact Factor: 5.42). 10/2000; 55(10):M554-9. DOI: 10.1093/gerona/55.10.M554
Source: PubMed


One of the major goals of home care is the prevention of hospitalization. The objective of this study was to examine the relation between medication use (number, type, and inappropriateness) and hospitalization among home care patients older than 65 years.
A retrospective chart review of 833 discharged older home care patients was performed. These patients were consecutive discharges from a single home care agency who either (a) returned to independent self-care or care of the family (S/F Care group) or (b) were admitted to the hospital (Hospitalized group). Medication assessment within these two groups included total number of medications (prescription and nonprescription); degree of polypharmacy (percentage of patients taking 5 or more, 7 or more, and 10 or more medications); and prevalence for different types of medications, including different types of inappropriate medications. Inappropriate medications were designated according to a list that was previously developed through a modified Delphi consensus technique by a panel of 13 experts in geriatric pharmacology and has been utilized in other studies. Student's t test was used for continuous variables and chi-square test was used for categorical variables to evaluate for differences between the S/F Care group and the Hospitalized group (p <.05). For comparisons of types of medications, p < .01 was used for significant differences, because of the high number of comparisons made.
Of 833 discharges, 644 (77.3%) returned to self-care or care of the Family (S/F Care group) and 189 (22.7%) were hospitalized. The Hospitalized group, compared with the S/F Care group, was taking a higher number of medications (mean +/- SD: 6.6+/-3.9 vs 5.7+/-3.4, p = .004), and had a higher percentage of patients taking 7 or more medications (46% vs 26%, p = .002) and 10 or more medications (21% vs 10%, p = .005), but not 5 or more medications. Only three types of medications were more commonly used among patients in the Hospitalized group than among patients in the S/F Care group: clonidine (4.2% vs 1.1%, p = .004); mineral supplements (23.8% vs 14.8%, p = .003); and metoclopramide (5.8% vs 2.0%, p = .006). The Hospitalized group had a lower percentage of patients taking inappropriate medications than did the S/F Care group (20% vs 27%, p = .040), but none of the types of inappropriate medications was used more often in either group.
This study shows a relationship between high levels of polypharmacy and hospitalization. Although it cannot be determined from this study whether a higher number of medications was an indicator of sicker patients at risk for hospitalization, or whether a higher number of medications might have directly led to hospitalization, polypharmacy should still be considered a marker for older home care patients for whom prevention of hospitalization is the goal.

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    • "Since ten or more dispensed drugs during a 3-month period is the most widely used definition of excessive polypharmacy [20–23], comparisons with other studies were possible. As a rule, the filling of one prescription covers consumption for a 3-month period in Sweden. "
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    ABSTRACT: Medication for elderly patients is often complex and problematic. Several criteria for classifying inappropriate prescribing exist. In 2010, the Swedish National Board of Health and Welfare published the document "Indicators of appropriate drug therapy in the elderly" as a guideline for improving prescribing for the elderly. The aim of this study was to assess trends in the prescription of inappropriate drug therapy in the elderly in Sweden from 2006 to 2013 using national quality indicators for drug treatment. Individual-based data on dispensed prescription drugs for the entire Swedish population aged ≥65 years during eight 3-month periods from 2006 to 2013 were accumulated. The data were extracted from the Swedish Prescribed Drug Register. Eight drug-specific quality indicators were monitored. For the entire population studied (n = 1,828,283 in 2013), six of the eight indicators showed an improvement according to the guidelines; the remaining two indicators (drugs with anticholinergic effects and excessive polypharmacy) remained relatively unchanged. For the subgroup aged 65-74 years, three indicators showed an improvement, four indicators remained relatively unchanged (e.g. propiomazine, and oxazepam) and one showed an undesirable trend (anticholinergic drugs) according to guidelines. For the older group (aged ≥75 years), all indicators except excessive polypharmacy showed improvement. According to the quality indicators used, the extent of inappropriate drug therapy in the elderly decreased from 2006 to 2013 in Sweden. Thus, prescribers appear to be more likely to change their prescribing patterns for the elderly than previously assumed.
    Drugs & Aging 04/2014; 31(5). DOI:10.1007/s40266-014-0165-5 · 2.84 Impact Factor
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    • "Unfortunately, currently the policy in Japan regarding withdrawal of a medicine from the one-dose package is left to the discretion of the patient. Medication nonadherence was reported as a costly problem.6,9,16,17 Since the cost of medication is paid on the national health insurance system in Japan, this action is not a costly problem. "
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    Patient Preference and Adherence 06/2013; 7:579-87. DOI:10.2147/PPA.S45012 · 1.68 Impact Factor
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    • "Up to 25% of ED consultations by elderly patients are due to drug-related problems (DRPs), depending on the definitions of DRP used [1-6]. Older patients are more frequently affected by DRPs than younger ones [1,2,7]. Contributing factors are physiologic changes associated with aging, which include impaired renal and hepatic function, as well as decreased total body water and lean body mass [8]. "
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    ABSTRACT: Since drug-related emergency department (ED) visits are common among older adults, the objectives of our study were to identify the frequency of drug-related problems (DRPs) among patients presenting to the ED with non-specific complaints (NSC), such as generalized weakness and to evaluate responsible drug classes. Delayed type cross-sectional diagnostic study with a prospective 30 day follow-up in the ED of the University Hospital Basel, Switzerland. From May 2007 until April 2009, all non-trauma patients presenting to the ED with an Emergency Severity Index (ESI) of 2 or 3 were screened and included, if they presented with non-specific complaints. After having obtained complete 30-day follow-up, two outcome assessors reviewed all available information, judged whether the initial presentation was a DRP and compared their judgment with the initial ED diagnosis. Acute morbidity (“serious condition”) was allocated to individual cases according to predefined criteria. The study population consisted of 633 patients with NSC. Median age was 81 years (IQR 72/87), and the mean Charlson comorbidity index was 2.5 (IQR 1/4). DRPs were identified in 77 of the 633 cases (12.2%). At the initial assessment, only 40% of the DRPs were correctly identified. 64 of the 77 identified DRPs (83%) fulfilled the criteria “serious condition”. Polypharmacy and certain drug classes (thiazides, antidepressants, benzodiazepines, anticonvulsants) were associated with DRPs. Elderly patients with non-specific complaints need to be screened systematically for drug-related problems. Trial Registration NCT00920491
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 03/2013; 21(1):15. DOI:10.1186/1757-7241-21-15 · 2.03 Impact Factor
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