Change in number of potentially inappropriate medications impacts on the nutritional status in a convalescent rehabilitation setting

Abstract

Aim The association between potentially inappropriate medications (PIM) use and nutritional status is unclear in Japan. The aim of the present study was to establish whether PIM use during hospitalization affects the nutritional status among geriatric patients in the convalescing stage. Methods This retrospective longitudinal cohort study included consecutive geriatric patients admitted and discharged from convalescent rehabilitation wards between 2010 and 2016. Participants were divided based on the presence or absence of increased PIM from admission to discharge. Demographic data, laboratory data and the Functional Independence Measure were analyzed between groups. We used the 2015 American Geriatrics Society Beers Criteria to screen for PIM, and the primary outcome was the Geriatric Nutritional Risk Index at discharge. A multiple linear regression analysis was used to examine whether Geriatric Nutritional Risk Index at discharge was independently associated with increased PIM. Results In total, 643 participants (220 men, 423 women; interquartile range 73–85 years) were included in the present study. Multiple linear regression analysis for increased PIM, adjusting for confounding factors, showed that PIM use was independently and negatively correlated with Geriatric Nutritional Risk Index at discharge. In particular, first‐generation antihistamine, antipsychotic, benzodiazepine, proton pump inhibitor and non‐steroidal anti‐ inflammatory drug use increased significantly from admission to discharge. Conclusions Increased PIM might be a predictor of nutritional status in geriatric patients. Geriatr Gerontol Int 2019; 19: 44–50.

Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine

“… 120 , 121 , 122 ) Recently, deprescribing polypharmacy in older sarcopenic patients undergoing convalescent rehabilitation was found to improve nutritional intake. 104 ) Therefore, the prevention and correction of polypharmacy may lead to improvements in malnutrition, 15 ) sarcopenia, and physical function in older adults.…”

“… 7 , 8 , 9 ) These prescribing practices are associated with significant costs and may have no obvious benefit to patients; however, they may have a significant impact on subsequent rehabilitation outcomes. Indeed, the association of polypharmacy and PIMs with decreased physical function and ADL, 10 , 11 , 12 , 13 ) cognitive decline, 14 ) and malnutrition 15 ) has been demonstrated in post-acute patients undergoing rehabilitation. 16 ) Therefore, pharmacotherapy needs to be performed in the rehabilitation medicine environment by a multidisciplinary team of medical professionals led by pharmacists.…”

Deprescribing Leads to Improved Energy Intake among Hospitalized Older Sarcopenic Adults with Polypharmacy after Stroke

“…Since the mainstay of treatment for sarcopenia includes nutritional therapy, this finding may be clinically important, suggesting that deprescribing and modifying polypharmacy in patients with sarcopenia may promote improvement in nutritional status. On the other hand, for each specific drug, increased number of PIMs [ 33 ] and anticholinergic load [ 34 ] are associated with malnutrition in older adults undergoing rehabilitation. However, the current study did not address the details of the specific medications that were reduced.…”

Polypharmacy and Malnutrition Management of Elderly Perioperative Patients with Cancer: A Systematic Review

“…Polypharmacy and anticholinergic drugs have also been associated with the risk of developing malnutrition [27][28][29]. The long-term use of multiple drugs results in anorexia, which generally manifests clinically because of a minor or serious impairment of the digestive tract, which may result in lower food intake and affect the patient's nutritional status.…”