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Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital: a prospective study.

Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital: a prospective study.
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Fabbietti P, Di Stefano G, Moresi R, Cassetta L, Di Rosa M, Fimognari F, Bambara V, Ruotolo G, Castagna A, Ruberto C, Lattanzio F, Corsonello A,


Fabbietti P, Di Stefano G, Moresi R, Cassetta L, Di Rosa M, Fimognari F, Bambara V, Ruotolo G, Castagna A, Ruberto C, Lattanzio F, Corsonello A, (click to view)

Fabbietti P, Di Stefano G, Moresi R, Cassetta L, Di Rosa M, Fimognari F, Bambara V, Ruotolo G, Castagna A, Ruberto C, Lattanzio F, Corsonello A,

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Aging clinical and experimental research 2017 11 11() doi 10.1007/s40520-017-0856-y
Abstract
BACKGROUND
Polypharmacy and potentially inappropriate medications (PIMs) are known to affect several negative outcomes in older patients. However, studies comparatively assessing polypharmacy and PIMs in relation to readmission are distinctively lacking.

AIMS
To compare the impact of polypharmacy and PIMs on 3-month readmission among older patients discharged from acute care hospital.

METHODS
Our series consisted of 647 patients consecutively enrolled in a multicenter observational study. The outcome of the study was the occurrence of any admission during the 3-month follow-up after discharge. Polypharmacy was defined as use of more than eight medications. PIMs were identified using 2015 version of Beers and Screening Tool of Older Persons Prescriptions (STOPP) criteria. Statistical analysis was performed using logistic regression models.

RESULTS
After adjusting for potential confounders, polypharmacy (OR 2.72, 95% CI 1.48-4.99) was found associated with the outcome, while Beers (OR 0.85, 95% CI 0.46-1.56), STOPP (OR 1.60, 95% CI 0.85-3.01), or combined Beers and STOPP violations (OR 0.99, 95% CI 0.57-1.74) were not. The association between polypharmacy and 3-month readmission was confirmed in logistic regression models including Beers (OR 2.88, 95% CI 1.55-5.34), STOPP (OR 2.64, 95% CI 1.43-4.87), or combined Beers and STOPP violations (OR 2.80, 95% CI 1.51-5.21).

DISCUSSION
Besides confirming that polypharmacy should be considered as a marker for readmission risk among older patients discharged from acute care hospital, our findings suggest that the association between polypharmacy and 3-month readmission is substantially independent of use of PIMs.

CONCLUSIONS
Polypharmacy, but not PIMs was significantly associated with readmission. Hospitalization should always be considered as a clue to individuate unnecessary polypharmacy and to reduce the burden of medications whenever possible.

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