title: Polypharmacy and medication regimen complexity as factors associated with hospital discharge destination among older people: a prospective cohort study.
abstract: 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).
  
  
  CONCLUSIONS
  Having high medication regimen complexity was inversely associated with discharge directly to home, while polypharmacy was not associated with discharge destination.
authors.affiliation: Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia, Barbara.Wimmer@monash.edu.
authors.forename: Barbara Caecilia
authors.initials: BC
authors.lastname: Wimmer
authors.forename: Elsa
authors.initials: E
authors.lastname: Dent
authors.forename: Renuka
authors.initials: R
authors.lastname: Visvanathan
authors.forename: Michael David
authors.initials: MD
authors.lastname: Wiese
authors.forename: Kristina
authors.initials: K
authors.lastname: Johnell
authors.forename: Ian
authors.initials: I
authors.lastname: Chapman
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D003663:Decision Trees; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D011446:Prospective Studies
chemical_list: D004364:Pharmaceutical Preparations