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International Journal of Clinical Pharmacy

, Volume 36, Issue 4, pp 750–756 | Cite as

Medication regimen complexity in institutionalized elderly people in an aging society

  • Ana Margarida AdvinhaEmail author
  • Sofia de Oliveira-Martins
  • Vanessa Mateus
  • Sara Grou Pajote
  • Manuel José Lopes
Research Article

Abstract

Background Complex medication regimens may adversely affect compliance and treatment outcomes. Complexity can be assessed with the medication regimen complexity index (MRCI), which has proved to be a valid, reliable tool, with potential uses in both practice and research. Objective To use the MRCI to assess medication regimen complexity in institutionalized elderly people. Setting Five nursing homes in mainland Portugal. Methods A descriptive, cross-sectional study of institutionalized elderly people (n = 415) was performed from March to June 2009, including all inpatients aged 65 and over taking at least one medication per day. Main outcome measure Medication regimen complexity index. Results The mean age of the sample was 83.9 years (±6.6 years), and 60.2 % were women. The elderly patients were taking a large number of drugs, with 76.6 % taking more than five medications per day. The average medication regimen complexity was 18.2 (±SD = 9.6), and was higher in the females (p < 0.001). The most decisive factors contributing to the complexity were the number of drugs and dosage frequency. In regimens with the same number of medications, schedule was the most relevant factor in the final score (r = 0.922), followed by pharmaceutical forms (r = 0.768) and additional instructions (r = 0.742). Conclusion Medication regimen complexity proved to be high. There is certainly potential for the pharmacist’s intervention to reduce it as part as the medication review routine in all the patients.

Keywords

Drug therapy complexity Elderly MRCI Nursing homes Portugal 

Notes

Acknowledgments

Special acknowledgment to the cooperation of nursing homes that participated in data Collection.

Funding

The authors did not receive any financial support.

Conflicts of interest

None.

References

  1. 1.
    United Nations. World Population Prospects: The 2010 Revision [Internet]. Popul. Div. 201 Available from: http://www.un.org/esa/population/.
  2. 2.
    Statistics Portugal. Census 2011—Provisional Results [Internet]. Censos 2011. 2011. Available from: http://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_destaques&DESTAQUESdest_boui=129675729&DESTAQUESmodo=2.
  3. 3.
    Bloom D, Boersch-Supan A. Population aging: facts, challenges and responses [Internet]. Boston; 2011. Available from: https://www.hsph.harvard.edu/pgda/WorkingPapers/2011/PGDA_WP_71.pdf.
  4. 4.
    World Health Organization. Healthy ageing—practical pointers on keeping well [Internet]. 2005. Available from: http://www.wpro.who.int/publications/docs/HealthyAgeingFinal.pdf.
  5. 5.
    Economist Intelligence Unit. Healthcare strategies for an ageing society [Internet]. 2009. Available from: http://graphics.eiu.com/upload/eb/Philips_Healthcare_ageing_3011WEB.pdf.
  6. 6.
    World Health Organization. Good health adds life to years—Global brief for World Health Day 2012 [Internet]. Geneva; 2012. Available from: http://whqlibdoc.who.int/hq/2012/WHO_DCO_WHD_2012.2_eng.pdf.
  7. 7.
    Mosegui GBG, Rozenfeld S, Veras RP, Vianna CMM. Avaliação da qualidade do uso de medicamentos em idosos. Rev Saú Públ. 1999;33(5):437–44.CrossRefGoogle Scholar
  8. 8.
    Murray MD, Callahan CM. Improving medication use for older adults: an integrated research agenda. Ann Intern Med. 2003;139(5 Pt 2):425–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Mannesse CK, Derkx FH, de Ridder MA, Man in’t Veld AJ, van der Cammen TJ. Adverse drug reactions in elderly patients as contributing factor for hospital admission: cross sectional study. BMJ. 1997;315(7115):1057–8.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Hanlon JT, Artz MB, Pieper CF, Lindblad CI, Sloane RJ, Ruby CM, et al. Inappropriate medication use among frail elderly inpatients. Ann Pharmacother. 2004;38(1):9–14.PubMedCrossRefGoogle Scholar
  11. 11.
    McDonald MV, Peng TR, Sridharan S, Foust JB, Kogan P, Pezzin LE, et al. Automating the medication regimen complexity index. JAMIA. 2013;20(3):499–505.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Ingersoll KS, Cohen J. The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008;31(3):213–24.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Mansur N, Weiss A, Beloosesky Y. Looking beyond polypharmacy: quantification of medication regimen complexity in the elderly. Am J Geriatr Pharmacother [Internet]. 2012 Aug [cited 2013 Dec 14];10(4):223–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22749668.
  14. 14.
    Corsonello A, Pedone C, Lattanzio F, Lucchetti M, Garasto S, Carbone C, et al. Regimen complexity and medication nonadherence in elderly patients. Ther Clin Risk Manag. 2009;5(1):209–16.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    George J, Phun YT, Bailey MJ, Kong DCM, Stewart K. Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004;38(9):1369–76.PubMedCrossRefGoogle Scholar
  16. 16.
    Melchiors AC, Correr CJ, Fernández-Llimos F. Translation and validation into Portuguese language of the medication regimen complexity index. Arq Bras Cardiol. 2007;89(4):210–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Castellar JI, Karnikowski MGO, Vianna LG, Nóbrega OT. Study of the pharmacotherapy prescribed for older-adult in a Brazilian long-term care facility. Acta Med Port. 2007;20:97–105.PubMedGoogle Scholar
  18. 18.
    Stange D, Kriston L, Von-Wolff A, Baehr M, Dartsch DC. Reducing cardiovascular medication complexity in a German university hospital: effects of a structured pharmaceutical management intervention on adherence. J Manag Care Pharm. 2013;19(5):396–407.PubMedGoogle Scholar
  19. 19.
    Elliott RA. Reducing medication regimen complexity for older patients prior to discharge from hospital: feasibility and barriers. J Clin Pharm Ther [Internet]. 2012 Dec [cited 2013 Dec 29];37(6):637–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22607618.
  20. 20.
    Centre for Home Care Policy and Research. Medication regimen complexity in home health care. [Internet]. 2011 [cited 2013 Dec 27]. Available from: http://toolkit.techandaging.org/2011/03/08/medication-regime-complexity-in-home-health-care/.
  21. 21.
    Bushardt RL, Massey EB, Simpson TW, Ariail JC, Simpson KN. Polypharmacy: misleading, but manageable. Clin Interv Aging. 2008;3(2):383–9.PubMedCentralPubMedGoogle Scholar
  22. 22.
    Chaimowicz F, Greco DB. Dynamics of institutionalization of older adults in Belo Horizonte. Braz Rev Saú Públ. 1999;33(5):454–60.CrossRefGoogle Scholar
  23. 23.
    Hanlon JT, Schmader KE, Ruby CM, Weinberger M. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc. 2001;49(2):200–9.PubMedGoogle Scholar
  24. 24.
    Oliveira-Martins S, Soares MA, Foppe van Mil JW, Cabrita J. Inappropriate drug use by Portuguese elderly outpatients-effect of the Beers criteria update. Pharm World Sci. 2006;28(5):296–301.PubMedCrossRefGoogle Scholar
  25. 25.
    Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA. 2002;287(3):337–44.PubMedCrossRefGoogle Scholar
  26. 26.
    Fialová D, Topinková E, Gambassi G, Finne-Soveri H, Jónsson PV, Carpenter I, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;293(11):1348–58.PubMedCrossRefGoogle Scholar
  27. 27.
    Sicras-Mainar A, de Cambra-Florensa S, Navarro-Artieda R. Consumption of oral analgesics and dosage forms in elderly patients: population-based study. Farm Hosp. 2009;33(3):161–71.PubMedCrossRefGoogle Scholar
  28. 28.
    Muir AJ, Sanders LL, Wilkinson WE, Schmader K. Reducing medication regimen complexity. J Gen Intern Med. 2001;16(2):77–82.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Oosthuizen F, Dhoodhat E, Kazi S, Masondo B, Omarjee N. Assessing the complexity of medicine regimens—a pilot study. AJPP. 2011;5(16):1863–6.Google Scholar
  30. 30.
    Correr CJ, Melchiors AC, Fernandez-Llimos F, Pontarolo R. Effects of a pharmacotherapy follow-up in community pharmacies on type 2 diabetes patients in Brazil. Int J Clin Pharm. 2011;33(2):273–80.PubMedCrossRefGoogle Scholar
  31. 31.
    Elliott RA, O’Callaghan C, Paul E, George J. Impact of an intervention to reduce medication regimen complexity for older hospital inpatients. Int J Clin Pharm. 2013;35(2):217–24.PubMedCrossRefGoogle Scholar
  32. 32.
    Khalil H. A review of pharmacist recommendations in an aged care facility. Aust J Prim Health. 2011;17(1):35–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Zermansky AG, Alldred DP, Petty DR, Raynor DK, Freemantle N, Eastaugh J, et al. Clinical medication review by a pharmacist of elderly people living in care homes-randomised controlled trial. Age Ageing. 2006;35(6):586–91.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Ana Margarida Advinha
    • 1
    Email author
  • Sofia de Oliveira-Martins
    • 1
  • Vanessa Mateus
    • 2
  • Sara Grou Pajote
    • 3
  • Manuel José Lopes
    • 3
  1. 1.iMed.UL - Instituto de Investigação do MedicamentoFaculty of Pharmacy of the University of LisbonLisbonPortugal
  2. 2.Lisbon School of Health TechnologyPolytechnic Institute of LisbonLisbonPortugal
  3. 3.College of Nursing S. João de DeusUniversity of ÉvoraÉvoraPortugal

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