Characteristics of Outpatient Prescriptions for Frail Taiwanese Elders with Long-Term Care Needs

Objective To describe medication prescription patterns and associated factors among frail Taiwanese elders with long- term care needs defined as having physical or cognitive functioning impairments. Design Longitudinal observational study from July 2001 to June 2002. Setting Community and Institutions. Participants Nationally representative samples of 11338 elders from the 'Assessment of National Long-Term Care Need in Taiwan' ( ANLTCNT). Measurments National identification number for each subject was linked to the National Health Insurance (NHI) claims data for outpatient clinic visits, diagnoses and medication prescriptions. For point prevalence calculation, the day of maximum number of medications prescribed during the study year was used. Results The mean age was 78.2 + /- 7.4 years old, of whom 61% were women. The mean number of chronic condition categories was 2.9 +/- 1.8. On average, subjects visited 4.1 +/- 2.5 different healthcare organizations, 7.7 +/- 5.3 different physicians, and received 32.9 +/- 26.4 outpatient cares. The mean maximum number of prescriptions of the study year was 8.6 +/- 4.3; Eighty-four per cent of our experienced polypharmacy (prescribed with >= 5 drugs) and 31% had persistent polypharmacy (polypharmacy for >= 181 days). Increased contact with healthcare professionals and greater number of chronic condition categories were associated with the development of polypharmacy and persistent polypharmacy. Conclusion The excessive number of medication prescriptions and high prevalence of polypharmacy among frail Taiwanese elders raised major drug-safety concern. Multiple healthcare providers and clinic visits were strong correlates of polypharmacy. Policies should be directed to encourage the elderly to establish primary care relationships and to promote geriatric prescription principles to improve clinical managements and outcomes