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- Haasum, Ylva, et al.
(författare)
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Institutionalization as a Risk Factor for Inappropriate Drug Use in the Elderly : A Swedish Nationwide Register-Based Study
- 2012
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 46:3, s. 339-346
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Few studies have investigated institutionalization as a potential risk factor for potentially inappropriate drug use (PIDU). Sweden now has unique possibilities for comparisons of drug use in large populations of institutionalized and home-dwelling elderly through linkage of the Swedish Prescribed Drug Register (SPDR) with the Swedish Social Services Register. OBJECTIVE: To compare PIDU in institutionalized versus home-dwelling elderly persons in Sweden. METHODS: We conducted a cross-sectional retrospective study of 1,260,843 home-dwelling and 86,721 institutionalized elderly individuals. We analyzed data on age, sex, and dispensed drugs for individuals aged 65 years or older registered in the SPDR from July to September 2008. Data on type of housing were retrieved from the Social Services Register. The main outcome measures of PIDU were use of anticholinergic drugs, long-acting benzodiazepines, concurrent use of 3 or more psychotropics, and potentially serious drug-drug interactions (DDIs). RESULTS: Thirty percent of the institutionalized and 12% of the home-dwelling elderly were exposed to PIDU. Living in an institution was strongly associated with overall PIDU (OR 2.36; 95% Cl 2.29 to 2.44), use of anticholinergic drugs (OR 2.58; 95% Cl 2.48 to 2.68), long-acting benzodiazepines (OR 1.50; 95% Cl 1.41 to 1.60), and concurrent use of 3 or more psychotropics (OR 7.26; 95% Cl 6.96 to 7.59), after controlling for age, sex, and number of drugs (used as proxy for comorbidity). However, institutionalization was associated with a lower probability of potentially serious DDIs (OR 0.60; 95% Cl 0.55 to 0.65). CONCLUSIONS: Our results indicate that institutionalization is a potential risk factor for PIDU. This implies that more cautious prescribing is warranted in institutions, where the frailest and most vulnerable elderly individuals reside. Research is needed to identify underlying risk factors for PIDU within these settings.
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| 2. |
- Wimmer, Barbara C., et al.
(författare)
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Medication Regimen Complexity and Unplanned Hospital Readmissions in Older People
- 2014
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Ingår i: The Annals of Pharmacotherapy. - : SAGE Publications. - 1060-0280 .- 1542-6270. ; 48:9, s. 1120-1128
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Tidskriftsartikel (refereegranskat)abstract
- Background: Medication-related problems and adverse drug events are leading causes of preventable hospitalizations. Few previous studies have investigated the possible association between medication regimen complexity and unplanned rehospitalization. Objective: To investigate the association between discharge medication regimen complexity and unplanned rehospitalization over a I 2-month period. Method: The prospective study comprised patients aged >= 70 years old consecutively admitted to a Geriatrics Evaluation and Management (GEM) unit between October 2010 and December 2011. Medication regimen complexity at discharge was calculated using the 65-item validated Medication Regimen Complexity Index (MRCI). Cox proportional-hazards regression was used to compute unadjusted and adjusted hazard ratios (HRs) with 95% CIs for factors associated with rehospitalization over a 12-month follow-up period. Result: Of 163 eligible patients, 99 patients had one or more unplanned hospital readmissions. When adjusting for age, sex, activities of daily living, depression, comorbidity, cognitive status, and discharge destination, MRCI (HR = 1.01; 95% CI = 0.81-1.2), number of discharge medications (HR = 1.01; 95% CI = 0.94-1.08), and polypharnnacy (>= 9 medications; HR = 1.12; 95% CI = 0.69-1.80) were not associated with rehospitalization. In patients discharged to nonhome settings, there was an association between rehospitalization and the number of discharge medications (HR = 1.12; 95% CI = 1.01-1.25) and polypharmacy (HR = 2.24; 95% CI = 1.02-4.94) but not between rehospitalization and MRCI (HR = 1.32; 95% CI = 0.98-1.78). Conclusion: Medication regimen complexity was not associated with unplanned hospital readmission in older people. However, in patients discharged to nonhonne settings, the number of discharge medications and polypharmacy predicted rehospitalization. A patient's discharge destination is an important factor in unplanned medication-related readmissions.
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