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

  • Barbara Caecilia Wimmer
  • Elsa Dent
  • Renuka Visvanathan
  • Michael David Wiese
  • Kristina Johnell
  • Ian Chapman
  • J. Simon Bell
Original Research Article

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.

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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Barbara Caecilia Wimmer
    • 1
    • 2
  • Elsa Dent
    • 3
    • 4
  • Renuka Visvanathan
    • 3
    • 5
  • Michael David Wiese
    • 1
  • Kristina Johnell
    • 6
  • Ian Chapman
    • 3
  • J. Simon Bell
    • 1
    • 2
  1. 1.Sansom Institute, School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideAustralia
  2. 2.Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and SafetyMonash UniversityMelbourneAustralia
  3. 3.Discipline of MedicineUniversity of AdelaideAdelaideAustralia
  4. 4.Discipline of Public HealthUniversity of AdelaideAdelaideAustralia
  5. 5.Aged and Extended Care Services, The Queen Elizabeth Hospital and the Adelaide Geriatrics Training and Research with Aged Care (GTRAC) CentreUniversity of AdelaideAdelaideAustralia
  6. 6.Aging Research CenterKarolinska Institutet and Stockholm UniversityStockholmSweden

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