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

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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.

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Acknowledgments

No external sources of funding were used for this study. Barbara C. Wimmer received an International President’s Scholarship from the University of South Australia to undertake the research reported in this manuscript. Barbara C. Wimmer, Elsa Dent, Renuka Visvanathan, Michael D. Wiese, Kristina Johnell, Ian Champan, and J. Simon Bell have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia

    Barbara Caecilia Wimmer, Michael David Wiese & J. Simon Bell

  2. Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia

    Barbara Caecilia Wimmer & J. Simon Bell

  3. Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia

    Elsa Dent, Renuka Visvanathan & Ian Chapman

  4. Discipline of Public Health, University of Adelaide, Adelaide, SA, Australia

    Elsa Dent

  5. Aged and Extended Care Services, The Queen Elizabeth Hospital and the Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, University of Adelaide, Adelaide, SA, Australia

    Renuka Visvanathan

  6. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden

    Kristina Johnell

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  1. Barbara Caecilia Wimmer
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  2. Elsa Dent
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  7. J. Simon Bell
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Correspondence to Barbara Caecilia Wimmer.

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Wimmer, B.C., Dent, E., Visvanathan, R. et al. Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study. Drugs Aging 31, 623–630 (2014). https://doi.org/10.1007/s40266-014-0185-1

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  • DOI: https://doi.org/10.1007/s40266-014-0185-1

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