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Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital: a prospective study

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Abstract

Background

Polypharmacy and potentially inappropriate medications (PIMs) are known to affect several negative outcomes in older patients. However, studies comparatively assessing polypharmacy and PIMs in relation to readmission are distinctively lacking.

Aims

To compare the impact of polypharmacy and PIMs on 3-month readmission among older patients discharged from acute care hospital.

Methods

Our series consisted of 647 patients consecutively enrolled in a multicenter observational study. The outcome of the study was the occurrence of any admission during the 3-month follow-up after discharge. Polypharmacy was defined as use of more than eight medications. PIMs were identified using 2015 version of Beers and Screening Tool of Older Persons Prescriptions (STOPP) criteria. Statistical analysis was performed using logistic regression models.

Results

After adjusting for potential confounders, polypharmacy (OR 2.72, 95% CI 1.48–4.99) was found associated with the outcome, while Beers (OR 0.85, 95% CI 0.46–1.56), STOPP (OR 1.60, 95% CI 0.85–3.01), or combined Beers and STOPP violations (OR 0.99, 95% CI 0.57–1.74) were not. The association between polypharmacy and 3-month readmission was confirmed in logistic regression models including Beers (OR 2.88, 95% CI 1.55–5.34), STOPP (OR 2.64, 95% CI 1.43–4.87), or combined Beers and STOPP violations (OR 2.80, 95% CI 1.51–5.21).

Discussion

Besides confirming that polypharmacy should be considered as a marker for readmission risk among older patients discharged from acute care hospital, our findings suggest that the association between polypharmacy and 3-month readmission is substantially independent of use of PIMs.

Conclusions

Polypharmacy, but not PIMs was significantly associated with readmission. Hospitalization should always be considered as a clue to individuate unnecessary polypharmacy and to reduce the burden of medications whenever possible.

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Acknowledgements

This study was partially supported by a grant of the Italian Ministry of Health (Grant No. RF-2009-1530442).

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Authors and Affiliations

  1. Unit of Geriatric Pharmacoepidemiology, Italian National Research Center on Aging (INRCA), Cosenza, Italy

    Paolo Fabbietti, Mirko Di Rosa & Andrea Corsonello

  2. Scientific Direction, Italian National Research Center on Aging (INRCA), Ancona, Italy

    Giuseppina Di Stefano, Raffaella Moresi, Laura Cassetta & Fabrizia Lattanzio

  3. Unit of Geriatric Medicine, “Annunziata” Hospital, Cosenza, Italy

    Filippo Fimognari & Valentina Bambara

  4. Unit of Geriatric Medicine, “Pugliese-Ciaccio” Hospital, Catanzaro, Italy

    Giovanni Ruotolo, Alberto Castagna & Carmen Ruberto

Authors
  1. Paolo Fabbietti
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  2. Giuseppina Di Stefano
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  3. Raffaella Moresi
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  4. Laura Cassetta
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  11. Fabrizia Lattanzio
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  12. Andrea Corsonello
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Corresponding author

Correspondence to Paolo Fabbietti.

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The authors declare that they have no conflict of interest to declare.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Fabbietti, P., Di Stefano, G., Moresi, R. et al. Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital: a prospective study. Aging Clin Exp Res 30, 977–984 (2018). https://doi.org/10.1007/s40520-017-0856-y

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