title: Patient-level medication regimen complexity in older adults with depression.
abstract: OBJECTIVE
  Polypharmacy and medication adherence are well known challenges facing older adults. Medication regimen complexity increases the demands of self-care in the home. Some medication regimens may be more complex than others, especially when dosage form, frequency of dosing, and additional usage directions are included in complexity along with the number of medications In older adults with depression, it is unknown what features of their medications most influence their medication regimen complexity.
  
  
  METHODS
  A sample cohort of 100 adults ≥65 years old with a diagnosis of depression was randomly selected from electronic medical records (EMR) in ambulatory clinics at the University of Colorado (CU) and University of San Diego (SD). Demographic, medical history, and medication-related information was extracted from the EMR. Complexity was determined using the Medication Regimen Complexity Index (MRCI). IRB approval was obtained.
  
  
  RESULTS
  The cohort mean age was 74.3 years (SD) and 79.7 years (CU). The mean unweighted Charlson comorbidity index for 1.0 (SD) and 1.8 (CU). The mean number of medications was 7.1 and 8.0, with 1.1 and 1.2 depression meds, 5.4 and 4.3 non-depression prescription meds, and 0.6 and 2.4 OTC meds for the SD and CU cohorts, respectively. 66% of SD adults and 70% of CU adults took six or more meds. Individual MRCI scores were on average 17.62 (SD) and 19.36 (CU). Dosing frequency contributed to 57-58% of the MRCI score, with patients facing an average of 7-8 unique dosing frequencies in their regimen. In both cohorts, there was an average of 3 additional directions added to the regimens to clarify dosing.
  
  
  CONCLUSIONS
  As expected, in our older adult cohorts with depression the majority of patients took multiple medications. Using a standardized instrument, we characterized the regimen complexity and found that it was increasingly complex due to numerous dosing forms, frequencies and additional directions for use. Patient-level medication regimen complexity should go beyond depression medication to encompass the patient's entire regimen for opportunities to reduce complexity and improve ease of self-care.
authors.affiliation: Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado. Electronic address: sunny.linnebur@ucdenver.edu.
authors.forename: Sunny A
authors.initials: SA
authors.lastname: Linnebur
authors.affiliation: Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Vande Griend
authors.affiliation: Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado.
authors.forename: Kelli R
authors.initials: KR
authors.lastname: Metz
authors.affiliation: Colorado Health Outcomes Program, School of Medicine, University of Colorado, Aurora, Colorado.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Hosokawa
authors.affiliation: Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California; Veterans Affairs of San Diego Healthcare System, San Diego, California.
authors.forename: Jan D
authors.initials: JD
authors.lastname: Hirsch
authors.affiliation: Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado; Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Libby
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003863:Depression / Q000188:drug therapy*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D019338:Polypharmacy; D012648:Self Care
keywords: MRCI; aged; depression; geriatrics; medication adherence; medication regimen complexity