title: Polypharmacy and Medication Regimen Complexity as Risk Factors for Hospitalization Among Residents of Long-Term Care Facilities: A Prospective Cohort Study.
abstract: To investigate the association between polypharmacy and medication regimen complexity with time to first hospitalization, number of hospitalizations, and number of hospital days over a 12-month period.
  
  
  
  A 12-month prospective cohort study.
  
  
  
  A total of 383 residents of 6 Australian long-term care facilities (LTCFs).
  
  
  
  The primary exposures were polypharmacy (≥9 regular medications) and the 65-item Medication Regimen Complexity Index (MRCI). Cox proportional hazards regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between polypharmacy and MRCI with time to first hospitalization. Poisson regression was used to compute incident rate ratios (IRR) and 95% CIs for the association between polypharmacy and MRCI with number of hospitalizations and number of hospital days. Models were adjusted for age, sex, length of stay in LTCF, comorbidities, activities of daily living, and dementia severity.
  
  
  
  There were 0.56 (95% CI 0.49-0.65) hospitalizations per person-year and 4.52 (95% CI 4.31-4.76) hospital days per person-year. In adjusted analyses, polypharmacy was associated with time to first hospitalization (HR 1.84; 95% CI 1.21-2.79), number of hospitalizations (IRR 1.51; 95% CI 1.09-2.10), and hospital days per person-year (IRR 1.39; 95% CI 1.24-1.56). Similarly, in adjusted analyses a 10-unit increase in MRCI was associated with time to first hospitalization (HR 1.17; 95% CI 1.06-1.29), number of hospitalizations (IRR 1.15; 95% CI 1.06-1.24), and hospital days per person-year (IRR 1.19; 95% CI 1.16-1.23).
  
  
  
  Polypharmacy and medication regimen complexity are associated with hospitalizations from LTCFs. This highlights the importance of regular medication review for residents of LTCFs and the need for further research into the risk-to-benefit ratio of prescribing in this setting.
authors: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; Pharmacy Department, Austin Health, Melbourne, Australia. Electronic address: Samanta.Lalic@monash.edu.
authors: Samanta
authors: S
authors: Lalic
authors: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; NHMRC Cognitive Decline Partnership Center, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
authors: Janet K
authors: JK
authors: Sluggett
authors: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
authors: Jenni
authors: J
authors: Ilomäki
authors: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
authors: Barbara C
authors: BC
authors: Wimmer
authors: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors: Edwin C K
authors: EC
authors: Tan
authors: Resthaven Incorporated, Adelaide, Australia.
authors: Leonie
authors: L
authors: Robson
authors: Resthaven Incorporated, Adelaide, Australia.
authors: Tina
authors: T
authors: Emery
authors: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; NHMRC Cognitive Decline Partnership Center, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
authors: J Simon
authors: JS
authors: Bell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D006707:Homes for the Aged; D006760:Hospitalization; D006801:Humans; D008297:Male; D019338:Polypharmacy; D011446:Prospective Studies; D012307:Risk Factors
keywords: Polypharmacy; hospitalization; long-term care; medication regimen complexity; nursing homes