title: What happens to the medication regimens of older adults during and after an acute hospitalization?
abstract: BACKGROUND
  Hospitalized elderly patients are at risk for medication errors and nonadherence when discharged home.
  
  
  OBJECTIVE
  To describe how older patients' medications change during and after hospitalizations and what patients ultimately take after discharge.
  
  
  METHODS
  We conducted an observational cohort study of 95 patients aged 65 years and older admitted to Johns Hopkins Bayview Medical Center in 2007. Inclusion criteria included admissions longer than 24 hours and discharge to home. Medication lists from three periods were recorded: prehospitalization, day of discharge, and 3 days after discharge. In comparing lists, we characterized: new and discontinued medications, changes in dosage, and changes in frequency.
  
  
  RESULTS
  Before admission, patients were taking a total of 701 medications (mean, 7 per patient). Upon discharge, 192 new medicines were started (2.0 per patient), 76 discontinued (0.8 per patient), 67 changed in frequency, (0.7 per patient), and 45 changed in dosage (0.5 per patient). Antibiotics and antihypertensives were the most commonly prescribed new medications. Antihypertensives were also most likely to be discontinued. At day 3 after discharge, patients were adherent with 98% (763/778) of medications. However, 25% of antihypertensives and 88% analgesics discontinued by hospitalists on the day of discharge were reinitiated by patients upon their return home.
  
  
  CONCLUSIONS
  During hospitalizations, medications of older adults change substantially. Despite clear medication reconciliation efforts in the hospital environment, medication errors occur upon discharge to home. Because current standards are yielding suboptimal results, alternate methodologies for promoting medication adherence should also be considered, developed, and studied for effectiveness.
authors: Department of Hospital, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
authors: Ché Matthew
authors: CM
authors: Harris
authors: Anirudh
authors: A
authors: Sridharan
authors: Regina
authors: R
authors: Landis
authors: Eric
authors: E
authors: Howell
authors: Scott
authors: S
authors: Wright
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D059065:Medication Reconciliation / Q000706:statistics & numerical data*; D010351:Patient Discharge; D061214:Patient Safety; D019338:Polypharmacy; D016903:Drug Monitoring