Polypharmacy and hospitalization among older home care patients

Background, One of the major goals of home care is the prevention of hospit alization. The objective of this study was to examine the relation between medication use (number, type, and inappropriateness) and hospitalization am ong home care patients older than 65 years., Methods, A retrospective chart review of 833 discharged older home care pat ients was performed. These patients were consecutive discharges from a sing le home care agency who either (a) returned to independent self-care or car e of the family (S/F Care group) or (b) were admitted to the hospital (Hosp italized group). Medication assessment within these two groups included tot al number of medications (prescription and nonprescription); degree of poly pharmacy (percentage of patients taking 5 or more, 7 or more, and 10 or mor e medications); and prevalence for different types of medications, includin g different types of inappropriate medications. Inappropriate medications w ere designated according to a list that was previously developed through a modified Delphi consensus technique by a panel of 13 experts in geriatric p harmacology and has been utilized in other studies. Student's t test was us ed for continuous variables and chi-square test was used for categorical va riables to evaluate for differences between the S/F Care group and the Hosp italized group (p < .05). For comparisons of types of medications, p < .01 was used for significant differences, because of the high number of compari sons made. Results, Of 833 discharges, 644 (77.3%) returned to self-care or care of th e Family (SIF Care group) and 189 (22.7%) were hospitalized. The Hospitaliz ed group, compared with the S/F Care group, was taking a higher number of m edications (mean +/- SD: 6.6 +/- 3.9 vs 5.7 +/- 3.4, p =.004), and had a hi gher percentage of patients taking 7 or more medications (46% vs 26%, p = . 002) and 10 or more medications (21% vs 10%. p = .005), but not 5 or more m edications. Only three types of medications were more commonly used among p atients in the Hospitalized group than among patients in the SIF Care group : clonidine (4.2% vs 1.1%, p =.004): mineral supplements (23.8% vs 14.8%, p = .003); and metoclopramide (5.8% vs 2.0%, p = .006). The Hospitalized gro up had a lower percentage of patients taking inappropriate medications than did the S/F Care group (20% vs 27%, p = .040), but none of the types of in appropriate medications was used more often in either group. Conclusions, This study shows a relationship between high levels of polypha rmacy and hospitalization. Although it cannot be determined from this study whether a higher number of medications was an indicator of sicker patients at risk for hospitalization, or whether a higher number of medications mig ht have directly led to hospitalization, polypharmacy should still be consi dered a marker for older home care patients for whom prevention of hospital ization is the goal.