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      Polypharmacy in elderly patients at discharge from the acute care hospital

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          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.

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          Most cited references 32

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          Potential pitfalls of disease-specific guidelines for patients with multiple conditions.

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            Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society.

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              The abbreviated mental test: its use and validity.

              The validity of the Abbreviated Mental Test was demonstrated by comparison with final clinical diagnoses in a consecutive sample of 168 patients admitted with acute illness to a department of health care of the elderly. Fifty-eight (34%) had abnormal cognition. The best cut-off point was 8, with less than 8 suggesting abnormal cognitive function. A short version (the AMT7) of the AMT was developed. Its validity, internal consistency and coverage of domains was equivalent to the AMT but it had a slightly higher sensitivity (with acceptable specificity) than the original. This new short version may improve performance of junior doctors in clinical practice who appear to have difficulty remembering all 10 items of the AMT.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                March 2007
                March 2007
                : 3
                : 1
                : 197-203
                Affiliations
                [1 ]Italian National Research Center on Aging (INRCA) Cosenza, Italy
                [2 ]Chair of Geriatric Medicine, University Campus Bio-Medico Rome, Italy
                [3 ]Department of Internal Medicine, University of Messina Italy
                Author notes
                Correspondence: Andrea Corsonello Italian National Research Center on Aging (INRCA), Via D. Frugiuele, 39, I-87100 Cosenza, ITALY Tel +39 0984 68 21 11 Fax +39 0984 75 496 Email andrea_corsonello@ 123456tin.it
                Article
                1936300
                18360627
                © 2007 Dove Medical Press Limited. All rights reserved
                Categories
                Original Research

                Medicine

                comorbidity, polypharmacy, elderly, epidemiology

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