Clinical factors affecting potentially inappropriate medications at discharge in older stroke patients
Factors for increased in potentially inappropriate medications (PIMs) are poorly documented in a rehabilitation setting. The goal of this study is to identify clinical factors that are strongly associated with increased PIMs in stroke patients.
This retrospective cohort study included consecutive geriatric stroke patients in convalescent rehabilitation wards between 2010 and 2016. We investigated functional independence measure (FIM) and the characteristics of patients with and without PIMs at discharge. We used the 2015 American Geriatrics Society Beers Criteria to screen for PIMs. Multiple linear regression analysis was performed to analyze the relationship between PIM use and functional recovery.
In total, 418 participants (171 males, 247 females; median age 78 years; interquartile range 72–84 years) were included in the present study. Multiple linear regression analysis of PIMs use at discharge adjusting for potential confounders showed that gender, cardiac disease, diabetes mellitus, number of drugs at discharge, FIM-cognitive gain, and age are independent factors associated with PIMs prescribed at discharge (R2 = 0.384; p < 0.0001).
Potentially inappropriate medications use at discharge is negatively correlated with cognitive recovery of activities of daily living. This suggests that PIMs increase might have caused cognitive deterioration.
KeywordsCognitive function Convalescent rehabilitation ward Functional independence measure Stroke Potentially inappropriate medications
The authors thank the manager of Hitachinaka General Hospital who agreed for this study to take place.
Compliance with ethical standards
Conflict of interests
The authors declare no conflict of interest.
The ethics committee of the Hitachinaka General Hospital approved the present study. In addition, the present study was conducted with the approval of the Nihon University School of Pharmacy’s Ethics Committee.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 11.Hill-Taylor B, Sketris I, Hayden J, Byrne S, O’Sullivan D, Christie R (2013) Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. J Clin Pharm Ther 38:360–372CrossRefPubMedGoogle Scholar
- 12.Walston J, Hadley EC, Ferrucci L et al (2006) Research agenda for frailty in older adults: toward a better understanding of physiology and etiology:summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 54:508–513CrossRefGoogle Scholar
- 13.Nozaki S (2016) Medication and dysphagia. J JSPEN 31:699–704Google Scholar