Polypharmacy in elderly patients at discharge from the acute care hospital (original) (raw)

Abstract

Objective: To investigate correlates of polypharmacy at discharge from wards of general medicine and geriatrics. Population: 2465 patients enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) study. Main outcome measure: Polypharmacy, ie having more than 6 drugs prescribed at discharge. Methods: Data on drugs prescribed at home, during hospital stay, and at discharge were collected according to a validated procedure. Logistic regression analysis was used to identify independent correlates of polypharmacy at discharge. The adherence to current therapeutic guidelines was assessed for selected drugs (digitalis, diuretics, antithrombotics, bronchodilators) Results: The median number of prescribed drugs was 3.0 before admission and 4.0 at discharge (p < 0.001). Polypharmacy prior to admission (Odds Ratio [OR] 4.32, 95% Confidence Interval [CI] 3.13-5.96), cumulative comorbidity (OR 1.81, 95% CI 1.40-2.32) and selected chronic conditions (diabetes, heart failure, chronic obstructive pulmonary disease, renal insufficiency, and depression) were significant correlates of polypharmacy at discharge. Negative correlate of the outcome was the occurrence of adverse drug reactions prior to admission (OR 0.22, 95% CI 0.09-0.51). The rate of appropriate prescription reached 80% only for antithrombotics either at home or in hospital and at discharge. Conclusions: Hospitalization increases drug prescription at discharge in elderly patients. Efforts are needed to identify the determinants and to assess the quality of this prescription practice, with the final aim of contrasting polypharmacy.

Loading...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

References (37)

  1. American Thoracic Society. 1995. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 5(Pt 2):S77-S121.
  2. Antonelli Incalzi R, Pedone C, Pahor M, et al. 2001. Reasons prompting digitalis therapy in the acute care hospital. J Gerontol A Biol Sci Med Sci, 56:M361-5.
  3. Antonelli Incalzi R, Corsonello A, Pedone C, et al. 2005. Depression and drug utilization in an older population. Ther Clin Risk Manag, 1:55-60.
  4. Aronow WS. 1996. Prevalence of appropriate and inappropriate indications for use of digoxin in older patients at the time of admission to a nursing home. J Am Geriatr Soc, 44:588-90.
  5. Atkin PA, Shenfield GM. 1995. Medication-related adverse reactions and the elderly: a literature review. Adv Drug React Toxicol Rev, 14:175-91.
  6. Boyd CM, Darer J, Boult C, et al. 2005. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA, 294:716-24.
  7. Carosella L, Pahor M, Pedone C, et al. 1999. Pharmacosurveillance in hospitalized patients in Italy. Study design of the 'Gruppo Italiano di Farmacovigilanza nell'Anziano' (GIFA). Pharmacol Res, 40:287-95.
  8. Chang CM, Liu PY, Yang YH, et al. 2005. Use of the Beers criteria to predict adverse drug reactions among first-visit elderly outpatients. Pharmacotherapy, 25:831-8.
  9. Chen YF, Dewey ME, Avery AJ. 2001. Analysis Group of The Medical Research Council Cognitive Function and Ageing (MRCCFA) Study. Self-reported medication use for older people in England and Wales. J Clin Pharm Ther, 26:129-40. Polypharmacy in the elderly
  10. Corsonello A, Pedone C, Corica F, et al. 1999. Antihypertensive drug therapy and hypoglycemia in elderly diabetic patients treated with insulin and/or sulfonylureas. Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA). Eur J Epidemiol, 15:893-901.
  11. Corsonello A, Pedone C, Corica F, et al. 2005. Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients. Arch Intern Med, 165:790-5.
  12. Haas GJ, Young JB. 1999. Inappropriate use of digoxin in the elderly: how widespread is the problem and how can it be solved? Drug Saf, 20:223-30.
  13. Hajjar ER, Hanlon JT, Artz MB, et al. 2003. Adverse drug reaction risk factors in older outpatients. Am J Geriatr Pharmacother, 1:82-9.
  14. Jitapunkul S, Pillay I, Ebrahim S. 1991. The abbreviated mental test: its use and validity. Age Ageing, 20:332-6.
  15. Katz S, Ford AB, Moskowitz RW, et al. 1963. Studies of illness in aged: the index of ADL, a standardized measure of biological and psychosocial function. JAMA, 185:94-106.
  16. Kelly J, Chamber J. 2000. Inappropriate use of loop diuretics in elderly patients. Age Ageing, 29:489-93.
  17. Kwon OY, Jung DY, Kim Y, et al. 2003. Effects of ankle exercise combined with deep breathing on blood flow velocity in the femoral vein. Aust J Physiother, 49:253-8.
  18. Lenze EJ, Mulsant BH, Shear MK, et al. 2001. Comorbidity of depression and anxiety disorders in later life. Depress Anxiety, 14:86-93.
  19. Lesher EL, Berryhill JS. 1994. Validation of the Geriatric Depression Scale- Short Form among inpatients. J Clin Psychol, 50:256-60.
  20. Mannesse CK, Derkx FH, de Ridder MA, et al. 2000. Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing, 29:35-9.
  21. Masoudi FA, Baillie CA, Wang Y, et al. 2005. The complexity and cost of drug regimens of older patients hospitalized with heart failure in the United States, 1998-2001. Arch Intern Med, 165:2069-76.
  22. McCall WW. 2005. Diagnosis and management of insomnia in older people. J Am Geriatr Soc, 53(7 Suppl):S272-7.
  23. Naranjo CA, Busto U, Sellers EM, et al. 1981. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther, 30:239-45.
  24. Onder G, Pedone C, Landi F, et al. 2002. Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc, 50:1962-8.
  25. Onder G, Gambassi G, Scales CJ, et al. 2002. Adverse drug reactions and cognitive function among hospitalized older adults. Eur J Clin Pharmacol, 58:371-7.
  26. Onder G, Landi F, Cesari M, et al. 2003. Inappropriate medication use among hospitalized older adults in Italy: results from the Italian Group of Pharmacoepidemiology in the Elderly. Eur J Clin Pharmacol, 59:157-62.
  27. Onder G, Landi F, Liperoti R, et al. 2005. Impact of inappropriate drug use among hospitalized older adults. Eur J Clin Pharmacol, 61:453-9.
  28. Pahor M, Chrischilles EA, Guralnik JM, et al. 1994. Drug data coding and analysis in epidemiologic studies. Eur J Epidemiol, 10:405-11.
  29. Pirmohamed M, James S, Meakin S, et al. 2004. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ, 329:15-19.
  30. Radecki SE, Kane RL, Solomon DH, et al. 1988. Do physicians spend less time with older patients? J Am Geriatr Soc, 36:713-18.
  31. Rocca WA, Bonaiuto S, Lippi A, et al. 1992. Validation of the Hodkinson Abbreviated Mental Test as a screening instrument for dementia in an Italian population. Neuroepidemiology, 11:288-295.
  32. Simons LA, Tett S, Simons J, et al. 1992. Multiple medication use in the elderly. Use of prescription and non-prescription drugs in an Australian community setting. Med J Aust, 157:242-6.
  33. Somers A, Petrovic M, Robays H, et al. 2003. Reporting adverse drug reactions on a geriatric ward: a pilot project. Eur J Clin Pharmacol, 58:707-14.
  34. Stek ML, Gussekloo J, Beekman AT, et al. 2004. Prevalence, correlates and recognition of depression in the oldest old: the Leiden 85-plus study. J Affect Disord, 78:193-200.
  35. Tinetti ME, Bogardus ST Jr, Agostini JV. 2004. Potential pitfalls of disease- specific guidelines for patients with multiple conditions. N Engl J Med, 351:2870-4.
  36. van Kraaij DJ, Jansen RW, Gribnau FW, et al. 1998. Loop diuretics in patients aged 75 years or older: general practitioners' assessment of indications and possibilities for withdrawal. Eur J Clin Pharmacol, 54:323-7.
  37. World Health Organization. 1980. PHS-HCF. International classification of diseases, 9th revision. Clinical modifications. Public Health Service-Health Care Financing Administration, Washington, D.C.