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

Runganga, Maureen, Peel, Nancye M. and Hubbard, Ruth E. (2014) Multiple medication use in older patients in post-acute transitional care: a prospective cohort study. Clinical Interventions in Aging, 9 1453-1462. doi:10.2147/CIA.S64105

Author Runganga, Maureen
Peel, Nancye M.
Hubbard, Ruth E.
Title Multiple medication use in older patients in post-acute transitional care: a prospective cohort study
Journal name Clinical Interventions in Aging   Check publisher's open access policy
ISSN 1178-1998
Publication date 2014-09-03
Year available 2014
Sub-type Article (original research)
DOI 10.2147/CIA.S64105
Open Access Status DOI
Volume 9
Start page 1453
End page 1462
Total pages 10
Place of publication Auckland, New Zealand
Publisher Dove Medical Press
Collection year 2015
Language eng
Formatted 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.
Keyword Polypharmacy
Older people
Post-acute care
Functional outcomes
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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