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Clinical Pharmacist, Department of Geriatrics, Pharmacy Services, Rabin Medical Center, Beilinson Campus, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
Senior Physician, Department of Geriatrics, Rabin Medical Center, Beilinson Campus, Sackler School of Medicine, Tel Aviv University, Petach Tikvah
Head, Department of Geriatrics, Rabin Medical Center, Beilinson Campus, Sackler School of Medicine, Tel Aviv University
Reprints: Dr. Beloosesky, Department of Geriatrics, Rabin Medical Center, Beilinson Campus, Petach Tikvah, Israel 49372, fax 972-3-937-6817, beloy{at}clalit.org.il
BACKGROUND: Medication regimens are constantly modified and updated during a patient's hospitalization. These modifications and those made after discharge might increase the risk for nonadherence, polypharmacy, and poor outcomes among elderly patients.
OBJECTIVES: To investigate the extent of in-hospital modification of medication regimens of elderly patients and its relationship to medication adherence as well as one-month postdischarge drug regimen modifications and to examine the relationship of the modifications, adherence, and polypharmacy to mortality and readmissions 3 months postdischarge.
METHODS: Clinical and demographic data, postdischarge medication modifications, and adherence were prospectively obtained in 212 elderly patients. Inhospital drug regimen modifications were retrospectively recorded.
RESULTS: The average ± SD in-hospital medication regimen modification rate was 49.8% ± 28.4. No modifications were found in 9.7% of the patients. Using demographic and clinical parameters, we performed regression analysis and found that patients who were admitted with polypharmacy, discharged home, and cognitively normal experienced fewer medication modifications (p < 0.05). At one month postdischarge, the average medication regimen modification rate was 37.5% ± 25.4. In- and posthospital modifications were directly correlated (p = 0.047). Three months postdischarge, 17 patients had died and 50 had been readmitted. The independent risk factors for mortality were in-hospital modification rate of 50% or greater (OR 6.4; 95% CI 1.3 to 29.7), impaired cognition (OR 4.2; 95% CI 1.4 to 12.3), and each chronic disease (OR 1.2; 95% CI 1 to 1.5). No relationships were found between in-hospital medication regimen modifications and readmissions or with postdischarge modifications, adherence, and polypharmacy to mortality and readmissions.
CONCLUSIONS: Hospitalization of elderly patients is characterized by extensive medication regimen modifications, which are directly correlated with postdischarge modifications and may indicate an increased risk of mortality.
Key Words: adherence, elderly, hospitalization, medication modifications, mortality
Published Online, April 29, 2008. www.theannals.com, DOI 10.1345/aph.1L070
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