Drugs & Aging

, Volume 31, Issue 8, pp 623–630

Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study

Authors

    • Sansom Institute, School of Pharmacy and Medical SciencesUniversity of South Australia
    • Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and SafetyMonash University
  • Elsa Dent
    • Discipline of MedicineUniversity of Adelaide
    • Discipline of Public HealthUniversity of Adelaide
  • Renuka Visvanathan
    • Discipline of MedicineUniversity of Adelaide
    • Aged and Extended Care Services, The Queen Elizabeth Hospital and the Adelaide Geriatrics Training and Research with Aged Care (GTRAC) CentreUniversity of Adelaide
  • Michael David Wiese
    • Sansom Institute, School of Pharmacy and Medical SciencesUniversity of South Australia
  • Kristina Johnell
    • Aging Research CenterKarolinska Institutet and Stockholm University
  • Ian Chapman
    • Discipline of MedicineUniversity of Adelaide
  • J. Simon Bell
    • Sansom Institute, School of Pharmacy and Medical SciencesUniversity of South Australia
    • Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and SafetyMonash University
Original Research Article

DOI: 10.1007/s40266-014-0185-1

Cite this article as:
Wimmer, B.C., Dent, E., Visvanathan, R. et al. Drugs Aging (2014) 31: 623. doi:10.1007/s40266-014-0185-1

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.

Copyright information

© Springer International Publishing Switzerland 2014