Patterns and Predictors of Medication Change after Discharge from Hospital: An Observational Study in Older Adults with Neurological Disorders

Abstract

Background: Medication is often changed after inpatient treatment, which affects the course of the disease, health behavior and adherence. Thus, it is important to understand patterns of medication changes after discharge from hospital. Methods: Inpatients at the Department of Neurology received a comprehensive assessment during their stay, including adherence, depression, cognition, health and sociodemographic variables. A month after being discharged, patients were contacted to enquire about post-discharge medication changes. Results: 910 older adults aged 70 ± 8.6 years participated, of which 204 (22.4%) reported medication changes. The majority of changes were initiated by physicians (n = 112, 56.3%) and only 25 (12.6%) patients reported adjusting medication themselves. Reasons for medication changes differed between patients and doctors (p < 0.001), with side effects or missing effects cited frequently. Sociodemographic and patient-related factors did not significantly predict medication changes. Conclusion: Patients reported less post-discharge medication changes than expected, and contrary to previous literature on nonadherence, only a fraction of those changes were performed by patients themselves. Socioeconomic and clinical parameters regarding personality, mood and cognition were poorly associated with post-discharge medication changes. Instead, individual health-related factors play a role, with patient factors only indirectly influencing physicians’ decisions.