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RESEARCH REPORTS |
1 Clinical Pharmacist, Department of Geriatrics, Pharmacy Services, Rabin Medical Center,
Beilinson Campus, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
2 Senior Physician, Department of Geriatrics, Rabin Medical Center, Beilinson Campus, Sackler
School of Medicine, Tel Aviv University, Petach Tikvah
3 Head, Department of Geriatrics, Rabin Medical Center, Beilinson Campus, Sackler School of
Medicine, Tel Aviv University
* To whom correspondence should be addressed. E-mail: beloy{at}clalit.org.il.
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Abstract |
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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.
OBJECTIVE: 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. In-hospital 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.
Reprints: Dr. Beloosesky, Department of Geriatrics, Rabin Medical Center, Beilinson Campus, Petach Tikvah, Israel 49372, fax 972-3-937-6817, beloy@clalit.org.il
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