Drug-related problems associated with community-dwelling older persons living alone in Singapore

Ang, Fengzhu; Pau, Jing En; Koh, En Wei; Loh, Nicholas Kwan Liang; Yeoh, Weini; Liang, Joshua Weiguang; Teng, Christine B; Yap, Kai Zhen

doi:10.1007/s11096-019-00813-7

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…Co-residing family could therefore act as a gatekeeper of costly ED admissions by monitoring health status, ensuring medical adherence and facilitating access to primary care services. In the absence of support from other household members, older adults living alone could be less aware of their health, have worse adherence to medication regimes and have difficulties accessing primary care services on their own [37][38][39][40]. Ultimately, this could aggravate age related complications and result in emergency situations requiring immediate medical care [69].…”

Section: Discussionmentioning

confidence: 99%

“…This is because older adults living alone are widely heterogeneous in their physical, social and psychological capabilities [33][34][35][36]. While some are functionally independent and have no chronic diseases, others may deal with multimorbidity without support, which could lead to further complications and emergency hospitalizations [37][38][39][40][41][42]. Hence, studying if the association of living alone on ED admissions is modified by multimorbidity could help assess individual risks with more precision.…”

Section: Introductionmentioning

confidence: 99%

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Emergency hospital admissions among older adults living alone in the community

Barrenetxea

Tan

Tong

et al. 2021

BMC Health Serv Res

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Background Among older adults, living alone is often associated with higher risk of Emergency Department (ED) admissions. However, older adults living alone are very heterogeneous in terms of health. As more older adults choose to live independently, it remains unclear if the association between living alone and ED admissions is moderated by health status. We studied the association between living alone and ED admission outcomes (number of admissions, inpatient days and inpatient costs) among older adults with and without multimorbidity. Methods We used data from 16,785 individuals of the third follow-up of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age: 73(61-96) years). Participants were interviewed face-to-face from 2014 to 2016 for sociodemographic/health factors and followed-up for one year on ED admission outcomes using Singapore Ministry of Health’s Mediclaim Database. We first applied multivariable logistic regression and two-part models to test if living alone is a risk factor for ED admission outcomes. We then ran stratified and joint effect analysis to examine if the associations between living alone and ED admission outcomes were moderated by multimorbidity. Results Compared to living with others, living alone was associated with higher odds of ED admission [Odds Ratio (OR) 1.28, 95 % Confidence Interval(CI) 1.08-1.51)], longer inpatient days (+0.61, 95 %CI 0.25-0.97) and higher inpatient costs (+322 USD, 95 %CI 54-591). The interaction effects of living arrangement and multimorbidity on ED admissions and inpatient costs were not statistically different, whereas the interaction between living arrangements and multimorbidity on inpatient days was borderline significant (p-value for interaction=0.050). Compared to those living with others and without multimorbidity, the relative mean increase was 1.13 inpatient days (95 %CI 0.39-1.86) for those living alone without multimorbidity, and 0.73 inpatient days ( 95 %CI 0.29-1.17) for those living alone with multimorbidity. Conclusions Older adults living alone were at higher risk of ED admission and higher inpatient costs regardless of multimorbidity, while those living alone without multimorbidity had the longest average inpatient days. To enable aging in place while avoiding ED admissions, interventions could provide instrumental support and regular health monitoring to older adults living alone, regardless of their health status.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergency hospital admissions among older adults living alone in the community

Barrenetxea

Tan

Tong

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

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“…It was found that living alone increased the risk of having more than three DRPs by 4.24-fold in this study. This was also shown by a study that found that older people who lived alone were more non-adherent to medications, less capable of caring for themselves, and 1.9 times more likely to have a DRP 34…”

Section: Discussionmentioning

confidence: 64%

Drug-related problems at the heart of cardiac surgery

et al. 2023

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ObjectivesOptimal perioperative success in cardiac surgery requires precise management of drug treatment. This study aimed to determine the prevalence, types and associated factors of drug-related problems (DRPs) during the entire hospital stay.MethodsA prospective observational study was conducted at the department of cardiovascular surgery in a university hospital between November 2019 and March 2020. Patients with planned elective cardiac surgery, aged ≥18 years, were included. A clinical pharmacist collaboratively reviewed medications on a daily basis and identified DRPs.ResultsA total of 100 patients (60 male) were included; median (range) age was 62 (19–86) years, and median (IQR) length of stay in hospital was 15 (9) days. A total of 275 DRPs were identified (median (IQR) 3 (2–4)). The number of patients who had at least one DRP was 47 preoperatively, 55 in the postoperative intensive care unit, 100 in the postoperative ward, and 16 at discharge. In order to reduce bias because of the small sample size, Firth’s logistic regression analysis was conducted. Statistically significant variables according to univariate analysis were included into a logistic regression model. Therefore the length of hospital stay (OR 1.14, 95% CI 1.03 to 1.26, p=0.008), living arrangements (living alone) (OR 4.24, 95% CI 1.41 to 12.73, p=0.009), number of medications at admission (OR 1.32, 95% CI 1.09 to 1.59, p=0.002), and having coronary artery bypass graft surgery (OR 2.87, 95% CI 1.07 to 7.70, p=0.03) were associated with an increased risk for DRPs in the final model.ConclusionHospital stay carries an increased risk for DRPs, especially at the postoperative stage. Modifiable risk factors for DRPs can be managed by required interventions performed by a multidisciplinary healthcare team.

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