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Therapeutic Failure-Related Hospitalisations in the Frail Elderly

Drugs & Aging volume 23, pages 579–586 (2006)Cite this article

Abstract

Background and objective

Although therapeutic failure may be a common cause of drug-related morbidity in older adults, few studies have focused on this problem. The study objective was to determine the frequency and types of, and the factors associated with, therapeutic failure leading to hospitalisation in frail, elderly patients, using a new instrument named the Therapeutic Failure Questionnaire (TFQ).

Methods

The sample included 106 frail, hospitalised elderly patients enrolled in a 1-year-long health service intervention trial at 11 Veterans Affairs Medical Centres. The TFQ was developed by a team of clinicial geriatricians and tested for reliability by two clinical pharmacists and a geriatrician on a sample of 32 patients. To establish validity, a geriatrician retrospectively reviewed the computerised medication records and clinical charts for these patients and applied the TFQ to determine probable therapeutic failures at the time of hospital admission.

Results

Inter- and intra-rater reliability for the TFQ were very good = 0.82 for both). Overall, 11% of patients had one or more probable therapeutic failures (TFQ scores between 4 and 7) leading to hospitalisation. Cardiopulmonary disease was a common ‘indicator’ of therapeutic failure and was often the result of non-adherence. The only factor associated with therapeutic failure occurrence was severe chronic kidney disease (crude odds ratio 5.87; 95% CI 1.20, 28.69; p = 0.01).

Conclusions

The TFQ was able to identify several cases of probable therapeutic failure leading to hospitalisation in frail, elderly patients. Non-adherence to effective therapies for chronic serious cardiopulmonary disease was a common cause of therapeutic failure and represents a target for interventions to reduce hospitalisation. Further research on the occurrence, risk factors for and types of therapeutic failure is needed in a larger cohort of older non-veterans.

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Acknowledgements

Primary financial support was provided by grants from the National Institute on Aging (R01-AG-15432) and the Veterans Affairs Cooperative Study Program (006). Additional support was provided by grants R01-AG-14158 and P30-AG024827 from the National Institute on Aging, grant K24-AI-51324 from the National Institute of Allergy and Infectious Diseases, the VA Special Fellows Program in Advanced Geriatrics, and from the VFW Endowed Chair in Pharmacotherapy for the Elderly, College of Pharmacy, University of Minnesota. The funding agencies had no role in the design or conduct of the study.

The authors have no conflicts of interest relevant to the content of this study.

We would like to acknowledge the contributions of Richard J. Sloane MPH and Elizabeth C. Clipp RN, PhD for their help with data management and instrument development.

Author information

Affiliations

  1. Miller School of Medicine, Division of Gerontology and Geriatric Medicine and Geriatrics Institute, University of Miami, Miami, Florida, USA

    Robert M. Kaiser

  2. Geriatric Research Education and Clinical Center, Miami VA Healthcare System, Miami, Florida, USA

    Robert M. Kaiser

  3. Aging Center, Duke University Medical Center, Durham, North Carolina, USA

    Kenneth E. Schmader & Carl F. Pieper

  4. School of Medicine, Duke University Medical Center, Durham, North Carolina, USA

    Kenneth E. Schmader

  5. Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina, USA

    Kenneth E. Schmader

  6. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA

    Carl F. Pieper

  7. College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA

    Catherine I. Lindblad

  8. Veterans Affairs Medical Center, Minneapolis, Minnesota, USA

    Catherine I. Lindblad

  9. Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Christine M. Ruby &  Joseph T. Hanlon

  10. Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Joseph T. Hanlon

  11. Center for Health Equity Research, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA

    Joseph T. Hanlon

Authors
  1. Robert M. Kaiser
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  2. Kenneth E. Schmader
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  3. Carl F. Pieper
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  4. Catherine I. Lindblad
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  5. Christine M. Ruby
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  6. Joseph T. Hanlon
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Corresponding author

Correspondence to Joseph T. Hanlon.

Appendix

Appendix

Figure A1: Therapeutic failure questionnaire used in the study.

Fig. A1
figure 1

Therapeutic failure questionnaire.

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Kaiser, R.M., Schmader, K.E., Pieper, C.F. et al. Therapeutic Failure-Related Hospitalisations in the Frail Elderly. Drugs Aging 23, 579–586 (2006). https://doi.org/10.2165/00002512-200623070-00004

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Keywords

  • Chronic Obstructive Pulmonary Disease
  • Clinical Pharmacist
  • Therapeutic Failure
  • Cardiopulmonary Disease
  • Crude Odds Ratio