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Title: Polypharmacy and medication regimen complexity as risk factors for hospitalization among residents of long-term care facilities: a prospective cohort study
Austin Authors: Lalic, Samanta;Sluggett, Janet K;Ilomäki, Jenni;Wimmer, Barbara C;Tan, Edwin CK;Robson, Leonie;Emery, Tina;Bell, J Simon
Affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
Pharmacy Department, Austin Health, Melbourne, Victoria, Australia
NHMRC Cognitive Decline Partnership Center, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
Resthaven Incorporated, Adelaide, South Australia, Australia
Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
Issue Date: 1-Nov-2016
Publication information: Journal of the American Medical Directors Association 2016; 17(11): 1067.e1-1067.e6
Abstract: OBJECTIVES: To investigate the association between polypharmacy and medication regimen complexity with time to first hospitalization, number of hospitalizations, and number of hospital days over a 12-month period. DESIGN: A 12-month prospective cohort study. PARTICIPANTS AND SETTING: A total of 383 residents of 6 Australian long-term care facilities (LTCFs). MEASUREMENTS: The primary exposures were polypharmacy (≥9 regular medications) and the 65-item Medication Regimen Complexity Index (MRCI). Cox proportional hazards regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between polypharmacy and MRCI with time to first hospitalization. Poisson regression was used to compute incident rate ratios (IRR) and 95% CIs for the association between polypharmacy and MRCI with number of hospitalizations and number of hospital days. Models were adjusted for age, sex, length of stay in LTCF, comorbidities, activities of daily living, and dementia severity. RESULTS: There were 0.56 (95% CI 0.49-0.65) hospitalizations per person-year and 4.52 (95% CI 4.31-4.76) hospital days per person-year. In adjusted analyses, polypharmacy was associated with time to first hospitalization (HR 1.84; 95% CI 1.21-2.79), number of hospitalizations (IRR 1.51; 95% CI 1.09-2.10), and hospital days per person-year (IRR 1.39; 95% CI 1.24-1.56). Similarly, in adjusted analyses a 10-unit increase in MRCI was associated with time to first hospitalization (HR 1.17; 95% CI 1.06-1.29), number of hospitalizations (IRR 1.15; 95% CI 1.06-1.24), and hospital days per person-year (IRR 1.19; 95% CI 1.16-1.23). CONCLUSIONS: Polypharmacy and medication regimen complexity are associated with hospitalizations from LTCFs. This highlights the importance of regular medication review for residents of LTCFs and the need for further research into the risk-to-benefit ratio of prescribing in this setting.
DOI: 10.1016/j.jamda.2016.08.019
PubMed URL:
Type: Journal Article
Subjects: Polypharmacy
long-term care
medication regimen complexity
nursing homes
Appears in Collections:Journal articles

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