title: Medication transitions and polypharmacy in older adults following acute care.
abstract: OBJECTIVE
  Medication changes at transitions of care and polypharmacy are growing concerns that adversely impact optimal drug use. We aimed to describe transitions and patterns of medication use before and 1 year after older patients were hospitalized for community-acquired pneumonia, the second-most common reason for admission in North America.
  
  
  METHODS
  This was an analysis of a population-based clinical registry of patients treated in any of the six hospitals or seven emergency departments in Edmonton, Alberta, Canada, comprising 2,105 patients 65 years and older with community-acquired pneumonia who had survived at least 1 year. The prevalence of polypharmacy (five or more unique prescription drugs), as well as new use and persistence of common drug classes were assessed.
  
  
  RESULTS
  The mean age was 78 years (standard deviation 8 years), 50% were female, 62% were hospitalized, and 58% had severe pneumonia. Among the 2,105 patients, 949 (45%) were using five or more medications prior to hospitalization, increasing to 1,559 (74%) within 90 days postdischarge and remaining over 70% at 1 year. Overall, 1,690 (80%) patients newly started and 1,553 (74%) patients stopped at least one medication in the first 90 days of follow-up. The prevalence of the most common drug classes (ie, cardiovascular, alimentary/metabolism) remained stable, with the exception of anti-infective agents, whereby 25% of patients were dispensed an anti-infective agent 3 months to 1 year after hospitalization.
  
  
  CONCLUSIONS
  Most older patients with pneumonia are subject to polypharmacy, and almost every patient had a medication started or stopped during 1-year follow-up, with 25% using antibiotics again. The period following an episode of pneumonia represents an opportunity potentially to optimize pharmacotherapy.
authors.affiliation: School of Pharmacy, Memorial University of Newfoundland, St John's, NL, Canada.
authors.forename: John-Michael
authors.initials: JM
authors.lastname: Gamble
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Hall
authors.affiliation: Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Marrie
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Sadowski
authors.affiliation: Faculty of Medicine and Dentistry, Edmonton, AB, Canada.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.affiliation: School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Dean T
authors.initials: DT
authors.lastname: Eurich
keywords: community-acquired pneumonia; drug utilization; elderly; pharmacoepidemiology; polypharmacy