&lt;p&gt;Polypharmacy Among Home-Dwelling Older Adults: The Urgent Need for an Evidence-Based Medication Management Model&lt;/p&gt;

Pereira, Filipa; Gunten, Armin von; Amoussou, Joëlle Rosselet; Salamun, Isabella De Giorgi; Martins, Manuela; Verloo, Henk

doi:10.2147/ppa.s232575

Cited by 15 publications

(12 citation statements)

References 47 publications

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“…However, this prevalence was substantially lower (26.3–39.9%) among other European older adults living in the community, according to Midão and Giardini [ 25 ]. Bearing in mind that PP exposes older adults to greater risks of MRPs [ 19 , 20 , 27 ], and that MRPs are a frequent cause of functional decline, hospital readmission, and avoidable health costs [ 23 , 24 ], prescribing so many medications to this vulnerable population at hospital discharge is paradoxical and should be a public health concern [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…Comprehensive medication management is a critical function that assists in improving medication use, especially in those utilizing many medications to manage their multiple coexisting disease states. Older adults using multiple medications may be at risk of medication-related problems leading to adverse health outcomes [ 11 ]. Comprehensive medication management in the HBPC population is crucial as these patients have multiple comorbidities and most fit the criteria for polypharmacy.…”

Section: Introductionmentioning

confidence: 99%

Pharmacist medication review: An integrated team approach to serve home-based primary care patients

et al. 2021

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Background Comprehensive medication review is a patient-centered approach to optimize medication use and improve patient outcomes. This study outlines a pilot model of care in which a remote corporate-based clinical pharmacist implemented comprehensive medication reviews for a cohort of medically complex home-based primary care (HBPC) patients. Method Ninety-six medically complex patients were assessed for medication-related problems. Data collected on these patients were: number of chronic conditions, number of medications, appropriate indication for each medication, dose appropriateness, drug interactions, recommendations for medication optimization and deprescribing. The number of accepted recommendations by the HBPC practice was analyzed. Results On average, the patients were 82 years old and had 13 chronic conditions. They were taking a median of 17 medications. Over a four-month pilot period, 175 medication recommendations were made, and 53 (30.3%) of them were accepted, with most common being medication discontinuation, deprescribing, and dose adjustments. Sixty-four (66.7%) patients were on a medication listed as potentially inappropriate for use in older adults. The most common potentially inappropriate medication was a proton-pump inhibitor (38.5%), followed by aspirin (24%), tramadol (15.6%), a benzodiazepine (13.5%) or an opioid (8.3%). Eighty-one medications were recommended for deprescribing and 27 medications were discontinued (33.3%). There were 24 recommended dose adjustments and 11 medications were dose adjusted (45.8%). Thirty-four medications were suggested as an addition to the current patient regimen, 2 medications were added (5.9%). Conclusion Pharmacist comprehensive medication review is a necessary component of the HBPC healthcare continuum. Additional research is needed to examine whether aligning pharmacists to deliver support to HBPC improves clinical outcomes, reduces healthcare expenditures and improves the patient’s experience.

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“…National and international statistics document elevated rates of hospitalization and emergency department admissions among polymedicated, home-dwelling older adults with multiple chronic conditions, and these are often caused by medication-related problems (MRPs) [7][8][9][10]. However, the determining factors of medication-related hospitalizations are poorly understood and require more investigations based on existing patient data [11]. The associations between age, comorbidities, polypharmacy, and adverse effects on health outcomes and health care consumption have been reported in multiple studies of emergency departments and hospitals, but the underlying mechanisms have often been unclear [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Transforming a Patient Registry Into a Customized Data Set for the Advanced Statistical Analysis of Health Risk Factors and for Medication-Related Hospitalization Research: Retrospective Hospital Patient Registry Study

Taushanov¹,

Verloo²,

Wernli³

et al. 2021

JMIR Med Inform

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Background Hospital patient registries provide substantial longitudinal data sets describing the clinical and medical health statuses of inpatients and their pharmacological prescriptions. Despite the multiple advantages of routinely collecting multidimensional longitudinal data, those data sets are rarely suitable for advanced statistical analysis and they require customization and synthesis. Objective The aim of this study was to describe the methods used to transform and synthesize a raw, multidimensional, hospital patient registry data set into an exploitable database for the further investigation of risk profiles and predictive and survival health outcomes among polymorbid, polymedicated, older inpatients in relation to their medicine prescriptions at hospital discharge. Methods A raw, multidimensional data set from a public hospital was extracted from the hospital registry in a CSV (.csv) file and imported into the R statistical package for cleaning, customization, and synthesis. Patients fulfilling the criteria for inclusion were home-dwelling, polymedicated, older adults with multiple chronic conditions aged ≥65 who became hospitalized. The patient data set covered 140 variables from 20,422 hospitalizations of polymedicated, home-dwelling older adults from 2015 to 2018. Each variable, according to type, was explored and computed to describe distributions, missing values, and associations. Different clustering methods, expert opinion, recoding, and missing-value techniques were used to customize and synthesize these multidimensional data sets. Results Sociodemographic data showed no missing values. Average age, hospital length of stay, and frequency of hospitalization were computed. Discharge details were recoded and summarized. Clinical data were cleaned up and best practices for managing missing values were applied. Seven clusters of medical diagnoses, surgical interventions, somatic, cognitive, and medicines data were extracted using empirical and statistical best practices, with each presenting the health status of the patients included in it as accurately as possible. Medical, comorbidity, and drug data were recoded and summarized. Conclusions A cleaner, better-structured data set was obtained, combining empirical and best-practice statistical approaches. The overall strategy delivered an exploitable, population-based database suitable for an advanced analysis of the descriptive, predictive, and survival statistics relating to polymedicated, home-dwelling older adults admitted as inpatients. More research is needed to develop best practices for customizing and synthesizing large, multidimensional, population-based registries. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-030030

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<p>Polypharmacy Among Home-Dwelling Older Adults: The Urgent Need for an Evidence-Based Medication Management Model</p>

Cited by 15 publications

References 47 publications

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

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

Pharmacist medication review: An integrated team approach to serve home-based primary care patients

Transforming a Patient Registry Into a Customized Data Set for the Advanced Statistical Analysis of Health Risk Factors and for Medication-Related Hospitalization Research: Retrospective Hospital Patient Registry Study

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