What Happens to the Medication Regimens of Older Adults During and After an Acute Hospitalization?
- 1 September 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Patient Safety
- Vol. 9 (3), 150-153
- https://doi.org/10.1097/pts.0b013e318286f87d
Abstract
Hospitalized elderly patients are at risk for medication errors and nonadherence when discharged home. To describe how older patients' medications change during and after hospitalizations and what patients ultimately take after discharge. We conducted an observational cohort study of 95 patients aged 65 years and older admitted to Johns Hopkins Bayview Medical Center in 2007. Inclusion criteria included admissions longer than 24 hours and discharge to home. Medication lists from three periods were recorded: prehospitalization, day of discharge, and 3 days after discharge. In comparing lists, we characterized: new and discontinued medications, changes in dosage, and changes in frequency. Before admission, patients were taking a total of 701 medications (mean, 7 per patient). Upon discharge, 192 new medicines were started (2.0 per patient), 76 discontinued (0.8 per patient), 67 changed in frequency, (0.7 per patient), and 45 changed in dosage (0.5 per patient). Antibiotics and antihypertensives were the most commonly prescribed new medications. Antihypertensives were also most likely to be discontinued. At day 3 after discharge, patients were adherent with 98% (763/778) of medications. However, 25% of antihypertensives and 88% analgesics discontinued by hospitalists on the day of discharge were reinitiated by patients upon their return home. During hospitalizations, medications of older adults change substantially. Despite clear medication reconciliation efforts in the hospital environment, medication errors occur upon discharge to home. Because current standards are yielding suboptimal results, alternate methodologies for promoting medication adherence should also be considered, developed, and studied for effectiveness.Keywords
This publication has 9 references indexed in Scilit:
- Postdischarge Adverse Events in the ElderlyJournal of Patient Safety, 2009
- Relationship of In-Hospital Medication Modifications of Elderly Patients to Postdischarge Medications, Adherence, and MortalityAnnals of Pharmacotherapy, 2008
- Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care PhysiciansJAMA, 2007
- Represcription After Adverse Drug Reaction in the Elderly: A Descriptive StudyArchives of Internal Medicine, 2006
- Posthospital Medication DiscrepanciesArchives of Internal Medicine, 2005
- Nine key questions to address polypharmacy in the elderlyJournal of the American Academy of Physician Assistants, 2005
- Recent Patterns of Medication Use in the Ambulatory Adult Population of the United StatesJAMA, 2002
- Systems Analysis of Adverse Drug EventsJAMA, 1995
- Elderly Patients and Their Medication: A Post-discharge Follow-up StudyAge and Ageing, 1992