Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study
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 regi...
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| Veröffentlicht in: | Drugs & aging 2014-08, Vol.31 (8), p.623-630 |
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| creator | Wimmer, Barbara Caecilia Dent, Elsa Visvanathan, Renuka Wiese, Michael David Johnell, Kristina Chapman, Ian Bell, J. Simon |
| description | 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. |
| doi_str_mv | 10.1007/s40266-014-0185-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_521341</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1546218084</sourcerecordid><originalsourceid>FETCH-LOGICAL-c560t-2d882f6a96bf14d45bbe060613b7368ad42704c63f6e426b1786231279e3ecf63</originalsourceid><addsrcrecordid>eNp1kt1u1DAQhSMEoqXwANwgSwiJCwL-WyfpXbRLKVJRV_yJO8txJrsuSRzshLJPwusyy25bhLQXViznO2fG45MkTxl9zSjN3kRJuVIpZRJXPkvZveSYsaxIWaGK-3_3NOW8-HaUPIrxilKqOGcPkyMuc8XR4jj5vfTtZlib0Bm7IaavyQeonTWj8z35CCvXQU_mvhta-OVGJCI5M3b0IZIyRm-dGaEm125ck3MfBzealixctOi4ArKAOLp-Z1Z2vl-Ry7aGQJbg0fCUlGQZUAV2dD8By6x9GMmncao3j5MHjWkjPNl_T5IvZ28_z8_Ti8t37-flRWpnio4pr_OcN8oUqmqYrOWsqoAqqpioMqFyU0ueUWmVaBRIriqW4cUF41kBAmyjxEmS7nzjNQxTpYfgOhM22hun90ffcQd6xpmQDPniID8EX9-JboRMUJrLXEjUvjqoXbivpfZhpeOkGaNZti31coej748JJ6k7HCy0renBT1GzmcRHzNEc0ef_oVd-Cj0OTjMlVMZypShSbEdZHHoM0Nx2wKjeBkrvAqUxUHobKL1t4tneeao6qG8VNwlC4MUeMNGatgmmty7ecbmihVACOb6_PP7qVxD-afFg9T9sAOTX</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1636718660</pqid></control><display><type>article</type><title>Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study</title><source>MEDLINE</source><source>SpringerLink_现刊</source><creator>Wimmer, Barbara Caecilia ; Dent, Elsa ; Visvanathan, Renuka ; Wiese, Michael David ; Johnell, Kristina ; Chapman, Ian ; Bell, J. Simon</creator><creatorcontrib>Wimmer, Barbara Caecilia ; Dent, Elsa ; Visvanathan, Renuka ; Wiese, Michael David ; Johnell, Kristina ; Chapman, Ian ; Bell, J. Simon</creatorcontrib><description>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.</description><identifier>ISSN: 1170-229X</identifier><identifier>ISSN: 1179-1969</identifier><identifier>EISSN: 1179-1969</identifier><identifier>DOI: 10.1007/s40266-014-0185-1</identifier><identifier>PMID: 24862100</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Activities of daily living ; Aged ; Aged, 80 and over ; Australia ; Biological and medical sciences ; Cohort analysis ; Cohort Studies ; Decision Trees ; Dementia ; Elder care ; Female ; Geriatrics ; Geriatrics/Gerontology ; Health Services for the Aged ; Hospitalization ; Humans ; Internal Medicine ; Long term health care ; Male ; Medical sciences ; Medicin och hälsovetenskap ; Medicine ; Medicine & Public Health ; Nursing homes ; Older people ; Original Research Article ; Outcome Assessment (Health Care) ; Patient Discharge - statistics & numerical data ; Patients ; Pharmaceutical Preparations - administration & dosage ; Pharmacology. Drug treatments ; Pharmacology/Toxicology ; Pharmacotherapy ; Polypharmacy ; Prospective Studies ; Rehabilitation</subject><ispartof>Drugs & aging, 2014-08, Vol.31 (8), p.623-630</ispartof><rights>Springer International Publishing Switzerland 2014</rights><rights>2015 INIST-CNRS</rights><rights>Copyright Springer Science & Business Media Aug 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c560t-2d882f6a96bf14d45bbe060613b7368ad42704c63f6e426b1786231279e3ecf63</citedby><cites>FETCH-LOGICAL-c560t-2d882f6a96bf14d45bbe060613b7368ad42704c63f6e426b1786231279e3ecf63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40266-014-0185-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40266-014-0185-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28609363$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24862100$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-110771$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:130084834$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Wimmer, Barbara Caecilia</creatorcontrib><creatorcontrib>Dent, Elsa</creatorcontrib><creatorcontrib>Visvanathan, Renuka</creatorcontrib><creatorcontrib>Wiese, Michael David</creatorcontrib><creatorcontrib>Johnell, Kristina</creatorcontrib><creatorcontrib>Chapman, Ian</creatorcontrib><creatorcontrib>Bell, J. Simon</creatorcontrib><title>Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study</title><title>Drugs & aging</title><addtitle>Drugs Aging</addtitle><addtitle>Drugs Aging</addtitle><description>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.</description><subject>Activities of daily living</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Australia</subject><subject>Biological and medical sciences</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Decision Trees</subject><subject>Dementia</subject><subject>Elder care</subject><subject>Female</subject><subject>Geriatrics</subject><subject>Geriatrics/Gerontology</subject><subject>Health Services for the Aged</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Long term health care</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicin och hälsovetenskap</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Nursing homes</subject><subject>Older people</subject><subject>Original Research Article</subject><subject>Outcome Assessment (Health Care)</subject><subject>Patient Discharge - statistics & numerical data</subject><subject>Patients</subject><subject>Pharmaceutical Preparations - administration & dosage</subject><subject>Pharmacology. Drug treatments</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Polypharmacy</subject><subject>Prospective Studies</subject><subject>Rehabilitation</subject><issn>1170-229X</issn><issn>1179-1969</issn><issn>1179-1969</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1kt1u1DAQhSMEoqXwANwgSwiJCwL-WyfpXbRLKVJRV_yJO8txJrsuSRzshLJPwusyy25bhLQXViznO2fG45MkTxl9zSjN3kRJuVIpZRJXPkvZveSYsaxIWaGK-3_3NOW8-HaUPIrxilKqOGcPkyMuc8XR4jj5vfTtZlib0Bm7IaavyQeonTWj8z35CCvXQU_mvhta-OVGJCI5M3b0IZIyRm-dGaEm125ck3MfBzealixctOi4ArKAOLp-Z1Z2vl-Ry7aGQJbg0fCUlGQZUAV2dD8By6x9GMmncao3j5MHjWkjPNl_T5IvZ28_z8_Ti8t37-flRWpnio4pr_OcN8oUqmqYrOWsqoAqqpioMqFyU0ueUWmVaBRIriqW4cUF41kBAmyjxEmS7nzjNQxTpYfgOhM22hun90ffcQd6xpmQDPniID8EX9-JboRMUJrLXEjUvjqoXbivpfZhpeOkGaNZti31coej748JJ6k7HCy0renBT1GzmcRHzNEc0ef_oVd-Cj0OTjMlVMZypShSbEdZHHoM0Nx2wKjeBkrvAqUxUHobKL1t4tneeao6qG8VNwlC4MUeMNGatgmmty7ecbmihVACOb6_PP7qVxD-afFg9T9sAOTX</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>Wimmer, Barbara Caecilia</creator><creator>Dent, Elsa</creator><creator>Visvanathan, Renuka</creator><creator>Wiese, Michael David</creator><creator>Johnell, Kristina</creator><creator>Chapman, Ian</creator><creator>Bell, J. Simon</creator><general>Springer International Publishing</general><general>Adis International</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>DG7</scope></search><sort><creationdate>20140801</creationdate><title>Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study</title><author>Wimmer, Barbara Caecilia ; Dent, Elsa ; Visvanathan, Renuka ; Wiese, Michael David ; Johnell, Kristina ; Chapman, Ian ; Bell, J. Simon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c560t-2d882f6a96bf14d45bbe060613b7368ad42704c63f6e426b1786231279e3ecf63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Activities of daily living</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Australia</topic><topic>Biological and medical sciences</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Decision Trees</topic><topic>Dementia</topic><topic>Elder care</topic><topic>Female</topic><topic>Geriatrics</topic><topic>Geriatrics/Gerontology</topic><topic>Health Services for the Aged</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Long term health care</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicin och hälsovetenskap</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Nursing homes</topic><topic>Older people</topic><topic>Original Research Article</topic><topic>Outcome Assessment (Health Care)</topic><topic>Patient Discharge - statistics & numerical data</topic><topic>Patients</topic><topic>Pharmaceutical Preparations - administration & dosage</topic><topic>Pharmacology. Drug treatments</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Polypharmacy</topic><topic>Prospective Studies</topic><topic>Rehabilitation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wimmer, Barbara Caecilia</creatorcontrib><creatorcontrib>Dent, Elsa</creatorcontrib><creatorcontrib>Visvanathan, Renuka</creatorcontrib><creatorcontrib>Wiese, Michael David</creatorcontrib><creatorcontrib>Johnell, Kristina</creatorcontrib><creatorcontrib>Chapman, Ian</creatorcontrib><creatorcontrib>Bell, J. 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Simon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study</atitle><jtitle>Drugs & aging</jtitle><stitle>Drugs Aging</stitle><addtitle>Drugs Aging</addtitle><date>2014-08-01</date><risdate>2014</risdate><volume>31</volume><issue>8</issue><spage>623</spage><epage>630</epage><pages>623-630</pages><issn>1170-229X</issn><issn>1179-1969</issn><eissn>1179-1969</eissn><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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>24862100</pmid><doi>10.1007/s40266-014-0185-1</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Drugs & aging, 2014-08, Vol.31 (8), p.623-630 |
| issn | 1170-229X 1179-1969 1179-1969 |
| language | eng |
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| subjects | Activities of daily living Aged Aged, 80 and over Australia Biological and medical sciences Cohort analysis Cohort Studies Decision Trees Dementia Elder care Female Geriatrics Geriatrics/Gerontology Health Services for the Aged Hospitalization Humans Internal Medicine Long term health care Male Medical sciences Medicin och hälsovetenskap Medicine Medicine & Public Health Nursing homes Older people Original Research Article Outcome Assessment (Health Care) Patient Discharge - statistics & numerical data Patients Pharmaceutical Preparations - administration & dosage Pharmacology. Drug treatments Pharmacology/Toxicology Pharmacotherapy Polypharmacy Prospective Studies Rehabilitation |
| title | Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study |
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