Polypharmacy in elderly patients at discharge from the acute care hospital

Abstract

Objective

To investigate correlates of polypharmacy at discharge from wards of general medicine and geriatrics.

Population

2465 patients enrolled in the Gruppo Italiano di Farmacovigilanza nell’Anziano (GIFA) study.

Main outcome measure

Polypharmacy, ie having more than 6 drugs prescribed at discharge.

Methods

Data on drugs prescribed at home, during hospital stay, and at discharge were collected according to a validated procedure. Logistic regression analysis was used to identify independent correlates of polypharmacy at discharge. The adherence to current therapeutic guidelines was assessed for selected drugs (digitalis, diuretics, antithrombotics, bronchodilators)

Results

The median number of prescribed drugs was 3.0 before admission and 4.0 at discharge (p < 0.001). Polypharmacy prior to admission (Odds Ratio [OR] 4.32, 95% Confidence Interval [CI] 3.13–5.96), cumulative comorbidity (OR 1.81, 95% CI 1.40–2.32) and selected chronicconditions (diabetes, heart failure, chronic obstructive pulmonary disease, renal insufficiency, and depression) were significant correlates of polypharmacy at discharge. Negative correlate of the outcome was the occurrence of adverse drug reactions prior to admission (OR 0.22, 95% CI 0.09–0.51). The rate of appropriate prescription reached 80% only for antithrombotics either at home or in hospital and at discharge.

Conclusions

Hospitalization increases drug prescription at discharge in elderly patients. Efforts are needed to identify the determinants and to assess the quality of this prescription practice, with the final aim of contrasting polypharmacy.