Journal of Gerontology:
2000, Vol. 55A, No. 10, M554–M559
MEDICAL SCIENCESCopyright 2000 by The Gerontological Society of America
Polypharmacy and Hospitalization Among Older
Home Care Patients
Joseph H. Flaherty,
Horace M. Perry III,
Garrett S. Lynchard,
and John E. Morley
Division of Geriatric Medicine, Saint Louis University Medical School, Missouri.
Geriatric Research Education and Clinical Center, Saint Louis VA Medical Center, Missouri.
Midwest Research Institute, Kansas City, Missouri.
was to examine the relation between medication use (number, type, and inappropriateness) and hospitalization among
home care patients older than 65 years.
One of the major goals of home care is the prevention of hospitalization. The objective of this study
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 (per-
centage of patients taking 5 or more, 7 or more, and 10 or more medications); and prevalence for different types of med-
ications, 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
test was used for categorical variables to evaluate for differences between the S/F Care group and the Hospitalized group
.05). For comparisons of types of medications,
.01 was used for significant differences, because of the high
number of comparisons made.
A retrospective chart review of 833 discharged older home care patients was performed. These patients
test was used for continuous variables and chi-square
(22.7%) were hospitalized. The Hospitalized group, compared with the S/F Care group, was taking a higher number of
3.9 vs 5.7
.004), and had a higher percentage of patients taking 7 or more
medications (46% vs 26%,
.002) and 10 or more medications (21% vs 10%,
tions. 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%,
and metoclopramide (5.8% vs 2.0%,
.006). The Hospitalized group had a lower percentage of patients taking inap-
propriate medications than did the S/F Care group (20% vs 27%,
ications was used more often in either group.
Of 833 discharges, 644 (77.3%) returned to self-care or care of the Family (S/F Care group) and 189
.005), but not 5 or more medica-
.004); mineral supplements (23.8% vs 14.8%,
.040), but none of the types of inappropriate med-
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.
This study shows a relationship between high levels of polypharmacy and hospitalization. Although it
HE home care component is the fastest growing portion
of the Medicare budget (1). Factors affecting this in-
crease include the aging of the population, shorter hospital
stays, and an emphasis on outpatient care. For many years,
home care has been “under the gun” to prove itself, and one
way it has done so is by preventing hospitalization, a high-
cost, high-morbidity outcome. Many older studies on home
care had difficulty showing cost-effectiveness for outcomes
such as hospitalization because home care services were not
“targeted.” That is, many people who received home care
services may not have actually needed them, or they may
have received more services than they needed given how
sick they were (2). Thus, any information about home care
patients who become hospitalized while receiving home
care services compared with those who are not hospitalized
would help this goal of targeting to prevent hospitalization
(3,4). Previous studies have shown that home care patients
with congestive heart failure (5), lung disease (6), and de-
pressive symptoms (7) are at high risk for hospitalization
and that focused care can reduce rates of hospital admission.
This study examined the relationship between medication
use (particularly polypharmacy and types of medications)
and hospitalization among older home care patients.
A retrospective chart review of persons discharged from
the Visiting Nurse Association (VNA) Home Care Agency
(HCA) was undertaken. The year this study was performed,
the VNA was one of the largest nonprofit HCAs in St.
Louis. In 1994, it conducted more than 137,000 visits, and
more than 70% of the agency’s patients were over 65 years
of age. The population in this study was a typical home care
population in that the majority of its patients were elderly,
similar to the populations of other databases at that time (8).
Subjects were (a) consecutive discharges from May 24,
1994 to November 30, 1994; (b) over the age of 64; and (c)
discharged because the patient had completed home care
services and returned to S/F Care or had been hospitalized.
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POLYPHARMACY AND HOME CARE PATIENTS
This work was supported in part by the Expansion of Home Care into
Academic Medicine Grant from the John A. Hartford Foundation (New
York). This work was presented in part at the American Geriatrics Society
Annual Meeting in Washington, DC, May 9, 1997.
Address correspondence to Joseph H. Flaherty, MD, St. Louis Univer-
sity Medical Center, Geriatrics Division, 1402 S. Grand, Rm. M238, St.
Louis, MO 63104. E-mail: firstname.lastname@example.org
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Received July 1, 1999
Accepted March 29, 2000
Decision Editor: William B. Ershler, MD
ICD-9 Codes for Diagnostic Categories in Table 1
Diagnosis ICD-9 Codes
2. Arthritis, CTD
5. Diabetes mellitus
8. Fractures, sprains
10. Delirium, paranoia,
11. Coagulation defect, DVT,
other venous thrombosis
14. Undernutrition, dehydration,
malaise and fatigue
15. Cellulitis, dermatitis, or other
local skin condition
390-428 (excluding 401.9)
454; 707–707.9; 873–893.1
332–348.3; 434.9–436; 780.3
Note: CTD ? Connective tissue disease; DVT ? deep venous thrombosis.
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