Multiple medication use in older patients in post-acute transitional care: a prospective cohort study

TitleMultiple medication use in older patients in post-acute transitional care: a prospective cohort study
Publication TypeJournal Article
Year of Publication2014
AuthorsRunganga M., Peel N.M, Hubbard R.E
JournalClin Interv Aging
Volume9
Pagination1453-62
ISBN Number1176-9092
Accession Number25214773
Keywords*Continuity of Patient Care, *Polypharmacy, Activities of Daily Living, Aged, Aged, 80 and over, Comorbidity, Drug Interactions, Female, Frail Elderly, functional outcomes, Geriatric Assessment, Humans, Inappropriate Prescribing/*statistics & numerical data, Male, Older people, Polypharmacy, post-acute care, Prospective Studies, Risk Factors
Abstract

BACKGROUND: Older adults with a range of comorbidities are often prescribed multiple medications, which may impact on their function and cognition and increase the potential for drug interactions and adverse events. AIMS: This study investigated the extent of polypharmacy and potentially inappropriate medications in patients receiving post-discharge transitional home care and explored the associations of polypharmacy with patient characteristics, functional outcomes, and frailty. METHODS: A prospective observational study was conducted of 351 patients discharged home from hospital with support from six Transition Care Program (TCP) sites in two states of Australia. A comprehensive geriatric assessment was conducted at TCP admission and discharge using the interRAI Home Care assessment tool, with frailty measured using an index of 57 accumulated deficits. Medications from hospital discharge summaries were coded using the World Health Organization Anatomical Therapeutic Chemical Classification System. RESULTS: Polypharmacy (5-9 drugs) was observed in 46.7% and hyperpolypharmacy (>/= 10 drugs) in 39.2% of patients. Increasing numbers of medications were associated with greater number of comorbid conditions, a higher prevalence of diabetes mellitus, coronary heart disease, chronic obstructive pulmonary disease, dizziness, and dyspnea and increased frailty. At discharge from the program, the non-polypharmacy group (<5 drugs) had improved outcomes in Activities of Daily Living, Instrumental Activities of Daily Living and fewer falls, which was mediated because of lower levels of frailty. The commonest drugs were analgesics (56.8%) and antiulcer drugs (52.7%). The commonest potentially inappropriate medications were tertiary tricyclic antidepressants. CONCLUSION: Polypharmacy is common in older patients discharged from hospital. It is associated with frailty, falls, and poor functional outcomes. Efforts should be made to encourage regular medication reviews and rationalization of medications as part of discharge planning. Whether careful deprescribing improves outcomes in frail patients should be the focus of randomized trials.

DOI10.2147/cia.S64105
PMCID

PMC4158998

Alternate JournalClinical interventions in aging