Medication regimen complexity in institutionalized elderly people in an aging society

Abstract

Background Complex medication regimens may adversely affect compliance and treatment outcomes. Complexity can be assessed with the medication regimen complexity index (MRCI), which has proved to be a valid, reliable tool, with potential uses in both practice and research. Objective To use the MRCI to assess medication regimen complexity in institutionalized elderly people. Setting Five nursing homes in mainland Portugal. Methods A descriptive, cross-sectional study of institutionalized elderly people (n = 415) was performed from March to June 2009, including all inpatients aged 65 and over taking at least one medication per day. Main outcome measure Medication regimen complexity index. Results The mean age of the sample was 83.9 years (±6.6 years), and 60.2 % were women. The elderly patients were taking a large number of drugs, with 76.6 % taking more than five medications per day. The average medication regimen complexity was 18.2 (±SD = 9.6), and was higher in the females (p \ 0.001). The most decisive factors contributing to the complexity were the number of drugs and dosage frequency. In regimens with the same number of medications, schedule was the most relevant factor in the final score (r = 0.922), followed by pharmaceutical forms (r = 0.768) and additional instructions (r = 0.742). Conclusion Medication regimen complexity proved to be high. There is certainly potential for the pharmacist's intervention to reduce it as part as the medication review routine in all the patients.

Complexity of Medication Regimen Prescribed on Hospital Discharge in Paediatric and Geriatric Patients with Psychiatric Disorder

“…[11][12][13][14][15] The median number of drugs that each patient received on hospital discharge in the pediatric group was two while that in the geriatric group was five (p<0.001). The median MRCI score was significantly higher in the geriatric age group (15.5) in comparison to the pediatric group (7.5) (p<0.001).…”

“…[15][16][17] However, the studies differ with regard to the contribution of section A and C towards the final score. [15][16][17] We also assessed if gender was a factor that affected the number of drugs a patient received and if the MRCI score varied across genders. In the pediatric age group, the number of drugs prescribed and the MRCI score did not differ significantly between the genders.…”

“…This is in contrast to the observations from other studies in institutionalized elderly inpatients where female gender was associated with a higher MRCI score. [15][16][17][18] The difference is likely due to the different study setting and disease conditions studied. Our results showed a strong positive correlation between the number of drugs prescribed per prescription and the MRCI score.…”

Treatment of Osteoporosis in Australian Residential Aged Care Facilities: Update on Consensus Recommendations for Fracture Prevention

“…This medication review should be particularly focused on benzodiazepines, other psychotropic medications, and medicines that contribute to a high drug burden index (ie, those with anticholinergic or sedative properties). 6,[32][33][34] Other interventions to prevent falls have been multifactorial in nature and have addressed risk factors pertaining to the individual (eg, strength and balance training) as well as his or her ability to safely interact with the environment. A meta-analysis by Cameron et al 35 reported that multifactorial interventions reduce falls and risk of falling in hospitals and may do so in nursing care facilities.…”

“…6,7 Osteoporosis treatment is a particularly challenging area in RACFs. The majority of residents in this setting are at high risk of suffering a fracture, 8 but only a minority receives treatment according to their level of risk.…”