Abstract
Background: Population ageing is a worldwide phenomenon. It is common for older adults to develop multiple age-related illnesses and the prevalence of multimorbidity increases substantially with age. Multimorbid adults are frequently treated with several concurrent medications and the regimen may be complex requiring multiple steps in the preparation of a medication prior to its administration. Polypharmacy is a concerning trend and older adults have a 100% risk of experiencing adverse drug events when taking ten or more medications concurrently. Discharge summaries communicating the number of medications, changes made to medication regimens during hospitalisations and the requirement for ongoing monitoring in the community are often incomplete. The aim of this study was to investigate contributing factors to medication-related hospitalisation, length of stay or readmission in older community-dwelling persons and examine the quality of discharge summaries. Methods: Descriptive and correlational analyses of demographic, clinical, admission, readmission, length of stay and medication variables were examined in Australia in 2016-2018. Discharge summaries were analysed for completeness, timeliness and interprofessional communication. Results: There were 295 participants, mean age 80 years, 55% were female, taking an average of 11 prescribed medications and with a mean Medication Regimen Complexity Index score of 34. Medication errors that were unrecognised at the time of hospitalisation were present in 19% of the sample. Factors associated with medication error were older age and a longer median length of stay. Fewer than 52% of these older patients had detailed discharge summaries. Conclusion: The prevalence of polypharmacy and medication regimen complexity at admission was high. A high proportion of older adults on medical units may have unrecognised medication errors impacting their admission. Medical discharge summaries are inadequately addressing this issue for patients returning to the care of their family physician.
Highlights
Medication error (ME) is a significant cause of adverse drug events (ADEs) [1]
Discharge summaries communicating the number of medications, changes made to medication regimens during hospitalisations and the requirement for ongoing monitoring in the community are often incomplete
A retrospective chart audit of 164 patients in major metropolitan teaching hospital in Australia revealed a mean age of 74 years, high co-morbidity score using the Charlson Comorbidity Index (CCI), a median of nine prescribed medications with 20% of patients from residential care and 37% living alone [20]
Summary
Medication error (ME) is a significant cause of adverse drug events (ADEs) [1]. An ADE can be defined as an undesirable pharmacological effect of a drug when administered at the recommended dose or, an unintentional overdose and ADE risk increases by 10% with each medication ingested, coming closer to 100% risk with ten or more medications [2]. Older adults experience more ADEs than younger adults because of age-related physiological and pharmacokinetic changes that reduce that body’s ability to deliver drugs to their target organs (distribution), decreased capacity to break down drugs (metabolism) or changes to the way in which the body removes waste products (clearance) [3] These physiological and pharmacokinetic changes are compounded by increased prevalence of multimorbidity and a concomitant increase in the number of medications prescribed in this population [4]. The aim of this study was to investigate contributing factors to medication-related hospitalisation, length of stay or readmission in older community-dwelling persons and examine the quality of discharge summaries.
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