Polypharmacy and medication regimen complexity as factors associated with hospital discharge destination among older people: a prospective cohort study

BACKGROUND: Older people often take multiple medications. It is a policy priority to facilitate older people to stay at home longer. Three-quarters of nursing home placements in the US are preceded by a hospitalization. OBJECTIVE: To investigate the association between polypharmacy and medication regimen complexity with hospital discharge destination among older people. METHODS: This prospective cohort study comprised patients aged ≥70 years consecutively admitted to the Geriatric Evaluation and Management unit at a tertiary hospital in Adelaide, Australia, between October 2010 and December 2011. Medication regimen complexity at discharge was calculated using the 65-item validated Medication Regimen Complexity Index (MRCI). Unadjusted and adjusted relative risks (RRs) with 95 % confidence intervals (CIs) were calculated for medication-related factors associated with discharge directly to home versus non-community settings (rehabilitation, transition care, and residential aged care). RESULTS: From 163 eligible patients, 87 were discharged directly to home (mean age 84.6 years, standard deviation [SD] 6.9; mean MRCI 26.1, SD 9.7), while 76 were discharged to non-community settings (mean age 85.8 years, SD 5.8; mean MRCI 29.9, SD 13.2). After adjusting for age, sex, comorbidity, and activities of daily living, having a high medication regimen complexity (MRCI >35) was inversely associated with discharge directly to home (RR 0.39; 95 % CI 0.20-0.73), whereas polypharmacy (≥9 medications) was not significantly associated with discharge directly to home (RR 0.97; 95 % CI 0.53-1.58). CONCLUSION: Having high medication regimen complexity was inversely associated with discharge directly to home, while polypharmacy was not associated with discharge destination.Barbara Caecilia Wimmer, Elsa Dent, Renuka Visvanathan, Michael David Wiese, Kristina Johnell, Ian Chapman, J. Simon Bel