Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study

Abstract

Purposes: We evaluated the prevalence and factors associated with polypharmacy and investigated the role of polypharmacy as a predictor of length of hospital stay and in-hospital mortality. Methods: Thirty-eight internal medicine wards in Italy participated in the Registro Politerapie SIMI (REPOSI) study during 2008. One thousand three hundred and thirty-two in-patients aged ≥65 years were enrolled. Polypharmacy was defined as the concomitant use of five or more medications. Linear regression analyses were used to evaluate predictors of length of hospital stay and logistic regression models for predictors of in-hospital mortality. Age, sex, Charlson comorbidity index, polypharmacy, and number of in-hospital clinical adverse events (AEs) were used as possible confounders. Results: The prevalence of polypharmacy was 51.9% at hospital admission and 67.0% at discharge. Age, number of drugs at admission, hypertension, ischemic heart disease, heart failure, and chronic obstructive pulmonary disease were independently associated with polypharmacy at discharge. In multivariate analysis, the occurrence of at least one AE while in hospital was the only predictor of prolonged hospitalization (each new AE prolonged hospital stay by 3.57 days, p<0.0001). Age [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.01-1.08; p=0.02), comorbidities (OR 1.18; 95% CI 1.12-1.24; p<0.0001), and AEs (OR 6.80; 95% CI 3.58-12.9; p<0.0001) were significantly associated with in-hospital mortality. Conclusions: Although most elderly in-patients receive polypharmacy, in this study, it was not associated with any hospital outcome. However, AEs were strongly correlated with a longer hospital stay and higher mortality risk. © 2011 Springer-Verlag

Risk factors for hospital readmission of elderly patients

“…No previous studies investigated the effect of AEs on hospital readmission, but our previous study [13] found that the occurrence of AEs in hospital (defined as any acute clinical problem that newly occurred during hospitalization [27]) was the most significant predictor for the extension of hospital stay by nearly 4 days and increased sevenfold the risk of in-hospital death. In this study AEs that occurred during index hospitalization were associated with the likelihood to be readmitted, confirming that also a development of a new clinical problem could represent one of the principal reasons for readmission [22].…”

“…The REPOSI is a collaborative and independent study of the Italian Society of Internal Medicine (SIMI) and the Mario Negri Institute of Pharmacological Research. The design was described in details elsewhere [13]. In brief, patients aged 65 years or older consecutively admitted to hospital during four periods that lasted four weeks and separated each from the other for three months, were enrolled in the study.…”

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

“…Perhaps an adequate antibiotic therapy may affect less clinical outcomes and mortality in complex elderly patients with multimorbidity and polypharmacy than in younger population. [9,21,22]. Data on the impact of comorbidities and combination therapies in the outcome of pneumonias in the elderly are still controversial and need to be further investigated.…”

“…The registry design was described in details elsewhere [9]. In brief, patients aged 65 years or more consecutively admitted to hospital during four index periods which lasted one week each separated from each other by 3 months were enrolled in the biannual study runs in 2008, 2010, and 2012. The principal data collected included socio-demographic factors, clinical parameters, patterns of comorbidities according to the Cumulative Illness Rating Scale (CIRS), and medications prescribed.…”

Effects of Polypharmacy on Adverse Drug Reactions among Geriatric outpatients at a Tertiary Care Hospital in Karachi, A prospective cohort study.

“…The elderly people now constitute more than 60% of the world population, which in turn increases their hospital visits leading to multiple medications' use [1]. Approximately there are 841 million elderly (60 years and older) people in the world.…”