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Polypharmacy in elderly patients at discharge from the acute care hospital

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Authors: Andrea Corsonello, Claudio Pedone, Francesco Corica, Raffaele Antonelli Incalzi, On behalf of the Gruppo Italiano di Farmacovigilanza nell’Anziano (GIFA) investigators

Published Date February 2007 Volume 2007:3(1) Pages 197 - 203
DOI: http://dx.doi.org/10.2147/TCRM.S

Andrea Corsonello1, Claudio Pedone2, Francesco Corica3, Raffaele Antonelli Incalzi2, On behalf of the Gruppo Italiano di Farmacovigilanza nell’Anziano (GIFA) investigators

1Italian National Research Center on Aging (INRCA), Cosenza, Italy; 2Chair of Geriatric Medicine, University Campus Bio-Medico, Rome, Italy; 3Department of Internal Medicine, University of Messina, Italy

Objective: To investigate correlates of polypharmacy at discharge from wards of generalmedicine 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 chronic conditions (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.

Keywords: polypharmacy, elderly, epidemiology, comorbidity