Abstract
Study designRetrospective cohort study.ObjectivesThe objectives for this study were to examine the prevalence of polypharmacy for people with traumatic spinal cord injury (SCI) following injury and to determine risk factors.SettingOntario, CanadaMethodsWe used provincial-level administrative health services data of publicly funded healthcare encounters housed at the Institute for Clinical Evaluative Sciences, Toronto, Ontario. We examined prescription medications dispensed over a 1 year period post injury for persons 66+ years with an index traumatic SCI between 2004 and 2014. Polypharmacy was defined as being on 10 or more drug classes. Descriptive and analytical statistics were conducted. Relative risks and 95% confidence limits for factors related to polypharmacy were calculated using a robust Poisson multivariate regression model.ResultsWe identified 418 cases of persons with traumatic SCI during the observation window. A total of 233 patients (56%) were taking at least 10 drug classes in the year following discharge from care for traumatic SCI. The mean number of drug classes taken post injury was 11 (SD = 6). Continuity of care was significantly associated with polypharmacy, with a higher continuity of care (having at least 75% of visits with the same doctor) reducing the risk of polypharmacy. The most common drugs prescribed were laxatives, opioids and cardiovascular-related drugs.ConclusionFindings suggest that polypharmacy is extensive among older adults with traumatic SCI. Persons with better continuity of care are less likely to have polypharmacy compared to those with less continuity.SponsorshipThis project was funded by a Connaught New Investigator Award (University of Toronto), and the Craig H. Neilsen Foundation Psychosocial Research Pilot Grant (Grant #441259).
Highlights
A traumatic spinal cord injury (SCI) is a devastating injury that causes significant burden to individuals, their family members, and society [1, 2]
Previous research has shown poor functional outcomes and high mortality rates following older onset SCI; reasons for these differences are poorly understood. To address this gap of research on older adults with SCI, this study examined the prevalence of polypharmacy post-SCI for older adults and the factors associated with polypharmacy using population-based administrative health data in Ontario, Canada
The mean (SD) number of drug classes taken in the year before SCI was 7.7 (5.7) and was significantly larger for women compared to men [8.8 (6.3) vs. 7.1 (5.2), p < 0.01]
Summary
A traumatic spinal cord injury (SCI) is a devastating injury that causes significant burden to individuals, their family members, and society [1, 2]. The age of incidence of SCI is bimodal, with peaks at the third and sixth decade [3]. Extended author information available on the last page of the article unintentional falls [3, 4]. Irrespective of age, episodic secondary health complications are common among persons with SCI, such as spasticity, urinary tract infections, pressure sores, respiratory infections [1, 2]. Other chronic conditions often include overuse upper extremity injuries, bowel and bladder problems, sleep disorders, chronic pain, fatigue, depression, diabetes, heart disease, and osteoarthritis [2, 5]
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