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

Maureen Runganga,1,2 Nancye M Peel,2 Ruth E Hubbard2,3 1The Prince Charles Hospital, Chermside, QLD, Australia; 2Centre for Research in Geriatric Medicine, The University of Queensland School of Medicine, QLD, Australia; 3Princess Alexandra Hospital, Woolloongabba, QLD, Australia Background: Older...

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Autores principales:	Runganga M, Peel NM, Hubbard RE
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Polypharmacy older people post-acute care functional outcomes Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/5c91e75b631f45c894fa8213417687b4
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spelling	oai:doaj.org-article:5c91e75b631f45c894fa8213417687b42021-12-02T07:20:09ZMultiple medication use in older patients in post-acute transitional care: a prospective cohort study1178-1998https://doaj.org/article/5c91e75b631f45c894fa8213417687b42014-09-01T00:00:00Zhttps://www.dovepress.com/multiple-medication-use-in-older-patients-in-post-acute-transitional-c-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Maureen Runganga,1,2 Nancye M Peel,2 Ruth E Hubbard2,3 1The Prince Charles Hospital, Chermside, QLD, Australia; 2Centre for Research in Geriatric Medicine, The University of Queensland School of Medicine, QLD, Australia; 3Princess Alexandra Hospital, Woolloongabba, QLD, Australia 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. Keywords: polypharmacy, older people, post-acute care, functional outcomesRunganga MPeel NMHubbard REDove Medical PressarticlePolypharmacyolder peoplepost-acute carefunctional outcomesGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 1453-1462 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Polypharmacy older people post-acute care functional outcomes Geriatrics RC952-954.6
spellingShingle	Polypharmacy older people post-acute care functional outcomes Geriatrics RC952-954.6 Runganga M Peel NM Hubbard RE Multiple medication use in older patients in post-acute transitional care: a prospective cohort study
description	Maureen Runganga,1,2 Nancye M Peel,2 Ruth E Hubbard2,3 1The Prince Charles Hospital, Chermside, QLD, Australia; 2Centre for Research in Geriatric Medicine, The University of Queensland School of Medicine, QLD, Australia; 3Princess Alexandra Hospital, Woolloongabba, QLD, Australia 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. Keywords: polypharmacy, older people, post-acute care, functional outcomes
format	article
author	Runganga M Peel NM Hubbard RE
author_facet	Runganga M Peel NM Hubbard RE
author_sort	Runganga M
title	Multiple medication use in older patients in post-acute transitional care: a prospective cohort study
title_short	Multiple medication use in older patients in post-acute transitional care: a prospective cohort study
title_full	Multiple medication use in older patients in post-acute transitional care: a prospective cohort study
title_fullStr	Multiple medication use in older patients in post-acute transitional care: a prospective cohort study
title_full_unstemmed	Multiple medication use in older patients in post-acute transitional care: a prospective cohort study
title_sort	multiple medication use in older patients in post-acute transitional care: a prospective cohort study
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/5c91e75b631f45c894fa8213417687b4
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Multiple medication use in older patients in post-acute transitional care: a prospective cohort study

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