Search

Aim To assess the impact of hospitalization on modification of drug burden among elderly patients. Methods The present prospective cohort study was carried out in acute care hospitals in Italy. The difference in the number of drugs used before hospital admission and those prescribed at discharge was calculated. The prevalence of (i) any increase (1 or more drugs); and (ii) an increase >50% in the number of drugs from admission to discharge was calculated, and the factors associated with these conditions were identified. Results The mean age of 1082 participants was 81.2 ± 7.3 years and 606 were women (56.0%), an increase in the number of drugs (1 or more drugs) between admission and discharge was observed in 672 participants (62.1% of study sample) and an “increase >50%” was observed in 372 participants (34.3%). “Any increase” was inversely associated with age and the number of drugs used before hospitalization, and it was positively associated with length of stay and diagnoses, including chronic obstructive pulmonary disease, ischemic heart disease and diabetes. “Increase >50%” was inversely associated with female sex, the number of drugs before hospitalization, involuntary loss of weight and intact cognitive status, and was positively associated with length of stay, chronic obstructive pulmonary disease, heart failure and diabetes. Conclusions Not only disease, but also demographic factors (age and gender) and geriatric syndromes (weight loss and cognitive status) might influence pharmacological burden. These data might be useful in order to target interventions aimed at improving drug use and reducing iatrogenic illness. Geriatr Gerontol Int 2015; ●●: ●●–●●. more...

Aim To investigate if older adults using multiple drugs have an increased risk of rehospitalization and mortality after hospital discharge. Methods This was a prospective cohort study carried out in acute care hospitals. The primary outcomes of the study were rehospitalization and mortality within 1 year after discharge from acute care hospitals. The study population was categorized in two groups according to the number of drugs prescribed at hospital discharge: no polypharmacy ( more...

Aim To assess the predictors of readmission among older adults hospitalized in acute care wards. Methods A prospective cohort study was carried out among 921 hospitalized older adults participating in the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) project. The primary outcome of the study was rehospitalization within 1 year after discharge from acute care hospitals. We assessed the participants with a questionnaire including 350 items about demographic, social and clinical characteristics. We analyzed all factors at discharge that could be considered predictors of readmission. Results The mean age of the participants was 81.2 years (SD 7.4 years), and 509 were women (55.3%). Overall, 280 of 921 patients (30.4%) were rehospitalized during the 1-year follow up of the study. Patients with a Mini-Mental State Examination score equal to or higher than 24 had a higher probability of rehospitalization, as compared with those who performed lower than 24 (OR 1.76, 95% CI 1.04–2.83). In addition, heart failure (OR 1.77, 95% CI 1.14–2.24), the number of falls during 1-year follow up (OR 1.15, 95% CI 1.05–1.28) and the number of drugs during first hospitalization (OR 1.15, 95% CI 1.01–1.07) were significantly associated with rehospitalization, whereas no significant association was shown for age, sex and walking speed for minimum size (OR 1.15, 95% CI 0.99–2.00). Conclusions Predictors of readmission in older people are an intact cognitive status; the presence of a geriatric condition, such as heart failure and falls; and a high number of drugs during first hospitalization. Further studies are required to assess the impact of home care for avoiding readmission in patients with an intact cognitive status, and supporting and treating patients with dementia. Geriatr Gerontol Int 2016; ••: ••–••. more...

Aim Several factors can affect antipsychotic prescriptions, among which, caregivers. However, whether being assisted by a care worker might increase the rate of antipsychotic prescriptions at discharge from acute care hospital has not been previously investigated. We aimed to investigate whether being assisted by a care worker is associated with increased use of antipsychotics among older patients discharged from acute care hospitals. Methods The present series consisted of 928 patients not taking antipsychotics at admission in seven acute care wards of geriatric medicine in Italy (mean age 80.8 ± 7.2 years, 54.9% women). The outcome of the study was defined as receiving an antipsychotic prescription at discharge. Patients were grouped according to their living conditions as follows: (i) living alone; (ii) living only with care worker; (iii) living with care worker and family members; and (iv) living only with family members. The association between study variables and antipsychotic prescription at discharge was investigated by logistic regression analysis. Results After adjusting for potential confounders, being assisted by care workers was significantly associated with the outcome (OR 2.64, 95% CI 1.21–5.75). Diagnosis of dementia (OR 2.73, 95% CI 1.65–4.51), instrumental activities of daily living limitations (OR 1.12, 95% CI 1.05–1.21) and delirium during stay (OR 3.87, 95% CI 2.01–7.47) also qualified as independent correlates of antipsychotic prescription at discharge. Conclusions Being assisted by care workers could increase the likelihood of receiving antipsychotics at discharge from acute care hospitals. Geriatr Gerontol Int 2017; 17: 1707–1713. more...