Original Research Article

Drugs & Aging

, Volume 31, Issue 8, pp 623-630

First online:

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

  • Barbara Caecilia WimmerAffiliated withSansom Institute, School of Pharmacy and Medical Sciences, University of South AustraliaFaculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University Email author 
  • , Elsa DentAffiliated withDiscipline of Medicine, University of AdelaideDiscipline of Public Health, University of Adelaide
  • , Renuka VisvanathanAffiliated withDiscipline of Medicine, University of AdelaideAged and Extended Care Services, The Queen Elizabeth Hospital and the Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, University of Adelaide
  • , Michael David WieseAffiliated withSansom Institute, School of Pharmacy and Medical Sciences, University of South Australia
  • , Kristina JohnellAffiliated withAging Research Center, Karolinska Institutet and Stockholm University
  • , Ian ChapmanAffiliated withDiscipline of Medicine, University of Adelaide
  • , J. Simon BellAffiliated withSansom Institute, School of Pharmacy and Medical Sciences, University of South AustraliaFaculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University

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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.