Association Between Unmet Needs for Medication Support and All-Cause Hospitalization in Community-Dwelling Disabled Elderly People

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2008.01676.x Byline: Masafumi Kuzuya (*), Yoshihisa Hirakawa (*), Yusuke Suzuki (*), Mitsunaga Iwata ([dagger]), Hiromi Enoki (*), Jun Hasegawa (*), Akihisa Iguchi (*) Keywords: medication management; mortality; hospitalization; elderly; unmet need Abstract: OBJECTIVES: To clarify the association between unmet medication management need and 3-year mortality and hospitalization for community-dwelling older people with various levels of disabilities. DESIGN: Prospective cohort study (the Nagoya Longitudinal Study for Frail Elderly). SETTING: Community-based. PARTICIPANTS: One thousand seven hundred seventy-two community-dwelling elderly subjects (611 men, 1,161 women). MEASUREMENTS: Data included the clients' demographic characteristics, a rating for basic and instrumental activities of daily living (ADLs), number of prescribed medications and physician-diagnosed chronic diseases, medication adherence, ability to manage medication, and presence or absence of medication assistance. Cox proportional hazard models and the Kaplan-Meier method were used to assess the association between the medication management at baseline and mortality or hospitalization during a 3-year period. RESULTS: Of 1,772 participants, 681 reported no difficulty with self-medication management, and 1,091 experienced difficulty with self-medication. Of participants with difficulty with self-medication management, 929 had medication assistance, and 162 did not. During a 3-year follow up, 424 participants died, and 758 were admitted to hospitals. The baseline data demonstrated that participants not receiving medication assistance were younger and had better ADL status and fewer comorbidities. Multivariate Cox regression models adjusting for potential confounders showed that the lack of assistance in those who needed medication assistance was associated with hospitalization but not mortality during the study period. CONCLUSION: In community-dwelling disabled elderly people, lack of medication assistance in those needing medication support was associated with higher risk of hospitalization. Author Affiliation: (*)Department of Geriatrics, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan ([dagger])Emergency Department, Nagoya Ekisaikai Hospital, Nakagawa-ku, Nagoya, Japan. Article note: Address correspondence to Masafumi Kuzuya, Department of Geriatrics, Nagoya University Graduate School of Medicine, 65 Tusruma-cho, Showa-ku, Nagoya 466-8550, Japan. E-mail: kuzuya@med.nagoya-u.ac.jp