Functional Status among Polymedicated Geriatric Inpatients at Discharge: A Population-Based Hospital Register Analysis

Abstract

This study explored and compared the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge. We used a cross-sectional registry of geriatric patients’ hospital records from a multi-site public hospital center in Switzerland. The analysis included all inpatients aged 65 years old or more admitted between 1 January 2015 and 31 December 2017 (n = 53,690), of whom 67.5% were polymedicated at hospital discharge, 52.1% were women (n = 18,909), and 42.7% were 75–84 years old (n = 15,485). On average, the polymedicated patients’ hospital lengths of stay were six days longer, they presented with more than three comorbidities, and they were prescribed more than nine medications at hospital discharge (p < 0.001). They showed more frequent general mobility decline (43.2% vs. 41.9%), gait disorders (46.2% vs. 43%), fatigue (48.6% vs. 43.4%) and dependence on lower-body care (49.7% vs. 47.6%), and presented a higher malnutrition risk (OR = 1.411; 95%CI 1.263–1.577; p < 0.001). However, the non-polymedicated inpatients had proportionally more physical and cognitive impairments. The comparison of the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge is important for clinicians trying to identify and monitor those who are most vulnerable to functional decline, and to design targeted strategies for the prevention of functional impairment and related adverse health outcomes.

Palliative care symptoms, concerns and well-being of older people with frailty and complex care needs upon hospital discharge: a cross-sectional study

“…However, little is known about the extent of older people's complex needs in the various domains relevant to health and care towards the end of life, that are, the physical, psychological, social, and spiritual domains. Previous research concerning older people upon hospital discharge mainly focused on their clinical characteristics and physical symptoms such as level of frailty [11], functional status [12,13], or on specific symptoms or concerns such as pain and anxiety [14]. But these data do not comprehensively cover the multidimensional needs and concerns relevant towards the end of life and their interrelationships.…”

Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study

“…Detailed quantitative23 28 29 and qualitative43 44 findings have been published in previous papers. Therefore, this section connects and integrates both sets of findings (table 1) and draws conclusions on how the qualitative results help to explain and extend specific quantitative results.…”

“…After approval by the Human Research Ethics Committee of the Canton of Vaud and our partnering hospital, a database containing the latter’s electronic health records from 1 January 2015 to 31 December 2017 for all inpatients aged 18 years or more (n=1 05 243) was provided to the research team in early 2019. This database was used to explore the functional status of polymedicated older adult inpatients at discharge (n=53 690 hospitalisation records) 23. However, the hospital’s data warehouse required more time to extract the database containing inpatients’ medication lists, and an updated database was provided at the end of 2019.…”

“…The active role that community pharmacists play in primary care is also expanding 22. The current trend in Switzerland’s healthcare system is to attempt to reduce hospital lengths of stay as much as possible and promote outpatient treatment, but this may lead to the ‘medication-intensive hospital discharge’ of geriatric inpatients 23. This is a major concern for public health that calls for a robust, integrated, multistakeholder model embedding medication management into the context of where and how older adults live, thus preventing the onset or progression of MRPs.…”

Telehealth Use and Hospital Readmission Rates in Long-term Care Facilities in Southeastern Minnesota During the COVID-19 Pandemic

“…Our findings are also consistent with those of multiple studies that have identified polypharmacy as a risk factor for hospitalization, longer length of hospital stay, and mortality risk in older patients. [22][23][24] The lower readmission rate of 10.2% overall likely reflects the dramatic change in hospitalization and rehospitalization during the COVID-19 pandemic. The patterns of hospital readmission changed after COVID-19 became an important cause of hospitalization.…”