Polypharmacy in Home Care in Europe: Cross-Sectional Data from the IBenC Study

Background Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe. Methods W...

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Published inDrugs & aging Vol. 35; no. 2; pp. 145 - 152
Main Authors Giovannini, Silvia, van der Roest, Henriëtte G., Carfì, Angelo, Finne-Soveri, Harriet, Garms-Homolová, Vjenka, Declercq, Anja, Jónsson, Pálmi V., van Hout, Hein, Vetrano, Davide L., Gravina, Ester Manes, Bernabei, Roberto, Onder, Graziano
Format Journal Article
LanguageEnglish
Published Cham Springer International Publishing 01.02.2018
Springer Nature B.V
Subjects
Age
Aging
Data collection
Geriatrics/Gerontology
Hospitals
Illnesses
Internal Medicine
Medicin och hälsovetenskap
Medicine
Medicine & Public Health
Older people
Original Research Article
Patients
Pharmacology/Toxicology
Pharmacotherapy
Polypharmacy
Prescription drugs
Substance abuse treatment
Systematic review
Netherlands
Belgium
Europe
Finland
Italy
Iceland
Germany
Online AccessGet full text

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Abstract Background Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe. Methods We conducted a cross-sectional analysis on 1873 HC patients from six European countries participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Data were collected using the interResident Assessment Instrument (interRAI) instrument for HC. Polypharmacy status was categorized into three groups: non-polypharmacy (0–4 drugs), polypharmacy (5–9 drugs), and excessive polypharmacy (≥ 10 drugs). Multinomial logistic regressions were used to identify variables associated with polypharmacy and excessive polypharmacy. Results Polypharmacy was observed in 730 (39.0%) HC patients and excessive polypharmacy in 433 (23.1%). As compared with non-polypharmacy, excessive polypharmacy was directly associated with chronic disease but also with female sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.17–2.13), pain (OR 1.51; 95% CI 1.15–1.98), dyspnea (OR 1.37; 95% CI 1.01–1.89), and falls (OR 1.55; 95% CI 1.01–2.40). An inverse association with excessive polypharmacy was shown for age (OR 0.69; 95% CI 0.56–0.83). Conclusions Polypharmacy and excessive polypharmacy are common among HC patients in Europe. Factors associated with polypharmacy status include not only co-morbidity but also specific symptoms and age.
AbstractList Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe. We conducted a cross-sectional analysis on 1873 HC patients from six European countries participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Data were collected using the interResident Assessment Instrument (interRAI) instrument for HC. Polypharmacy status was categorized into three groups: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs), and excessive polypharmacy (≥ 10 drugs). Multinomial logistic regressions were used to identify variables associated with polypharmacy and excessive polypharmacy. Polypharmacy was observed in 730 (39.0%) HC patients and excessive polypharmacy in 433 (23.1%). As compared with non-polypharmacy, excessive polypharmacy was directly associated with chronic disease but also with female sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.17-2.13), pain (OR 1.51; 95% CI 1.15-1.98), dyspnea (OR 1.37; 95% CI 1.01-1.89), and falls (OR 1.55; 95% CI 1.01-2.40). An inverse association with excessive polypharmacy was shown for age (OR 0.69; 95% CI 0.56-0.83). Polypharmacy and excessive polypharmacy are common among HC patients in Europe. Factors associated with polypharmacy status include not only co-morbidity but also specific symptoms and age.
BACKGROUNDHome care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe.METHODSWe conducted a cross-sectional analysis on 1873 HC patients from six European countries participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Data were collected using the interResident Assessment Instrument (interRAI) instrument for HC. Polypharmacy status was categorized into three groups: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs), and excessive polypharmacy (≥ 10 drugs). Multinomial logistic regressions were used to identify variables associated with polypharmacy and excessive polypharmacy.RESULTSPolypharmacy was observed in 730 (39.0%) HC patients and excessive polypharmacy in 433 (23.1%). As compared with non-polypharmacy, excessive polypharmacy was directly associated with chronic disease but also with female sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.17-2.13), pain (OR 1.51; 95% CI 1.15-1.98), dyspnea (OR 1.37; 95% CI 1.01-1.89), and falls (OR 1.55; 95% CI 1.01-2.40). An inverse association with excessive polypharmacy was shown for age (OR 0.69; 95% CI 0.56-0.83).CONCLUSIONSPolypharmacy and excessive polypharmacy are common among HC patients in Europe. Factors associated with polypharmacy status include not only co-morbidity but also specific symptoms and age.
Background Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe. Methods We conducted a cross-sectional analysis on 1873 HC patients from six European countries participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Data were collected using the interResident Assessment Instrument (interRAI) instrument for HC. Polypharmacy status was categorized into three groups: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs), and excessive polypharmacy (C10 drugs). Multinomial logistic regressions were used to identify variables associated with polypharmacy and excessive polypharmacy. Results Polypharmacy was observed in 730 (39.0%) HC patients and excessive polypharmacy in 433 (23.1%). As compared with non-polypharmacy, excessive polypharmacy was directly associated with chronic disease but also with female sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.17-2.13), pain (OR 1.51; 95% CI 1.15-1.98), dyspnea (OR 1.37; 95% CI 1.01-1.89), and falls (OR 1.55; 95% CI 1.01-2.40). An inverse association with excessive polypharmacy was shown for age (OR 0.69; 95% CI 0.56-0.83). Conclusions Polypharmacy and excessive polypharmacy are common among HC patients in Europe. Factors associated with polypharmacy status include not only co-morbidity but also specific symptoms and age.
[...]HC patients on polypharmacy and excessive polypharmacy presented a higher number of concomitant diseases; more specifically, COPD, CHD, heart failure, diabetes, and cancer were more common in these groups than in the non-polypharmacy group. [...]drug prescribing may be guided by weighing the patient's estimated life expectancy against the time required to achieve benefit from the medication treatment, and for this reason in the oldest old with a limited life expectancy use of many drugs may be avoided [29]. [...]memory loss, decline in intellectual function, and impaired judgment and language, commonly seen in patients with cognitive impairment, may cause communication difficulties, including decreased ability to report adverse effects [31]. [...]our study was not specifically designed to assess drug use and for this reason several relevant variables (i.e., use of drug administration aids) and diagnoses (i.e., hypertension and chronic kidney disease), which can have an impact on drug use and management, were not collected.
Background Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe. Methods We conducted a cross-sectional analysis on 1873 HC patients from six European countries participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Data were collected using the interResident Assessment Instrument (interRAI) instrument for HC. Polypharmacy status was categorized into three groups: non-polypharmacy (0–4 drugs), polypharmacy (5–9 drugs), and excessive polypharmacy (≥ 10 drugs). Multinomial logistic regressions were used to identify variables associated with polypharmacy and excessive polypharmacy. Results Polypharmacy was observed in 730 (39.0%) HC patients and excessive polypharmacy in 433 (23.1%). As compared with non-polypharmacy, excessive polypharmacy was directly associated with chronic disease but also with female sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.17–2.13), pain (OR 1.51; 95% CI 1.15–1.98), dyspnea (OR 1.37; 95% CI 1.01–1.89), and falls (OR 1.55; 95% CI 1.01–2.40). An inverse association with excessive polypharmacy was shown for age (OR 0.69; 95% CI 0.56–0.83). Conclusions Polypharmacy and excessive polypharmacy are common among HC patients in Europe. Factors associated with polypharmacy status include not only co-morbidity but also specific symptoms and age.
Author Gravina, Ester Manes
Vetrano, Davide L.
Carfì, Angelo
Finne-Soveri, Harriet
Declercq, Anja
Bernabei, Roberto
Onder, Graziano
Jónsson, Pálmi V.
van der Roest, Henriëtte G.
Giovannini, Silvia
Garms-Homolová, Vjenka
van Hout, Hein
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  organization: Department of Gerontology and Geriatrics, A. Gemelli Foundation, School of Medicine, Catholic University of the Sacred Heart, Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore
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  fullname: Onder, Graziano
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Snippet Background Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated...
Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug...
[...]HC patients on polypharmacy and excessive polypharmacy presented a higher number of concomitant diseases; more specifically, COPD, CHD, heart failure,...
BACKGROUNDHome care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated...
Background Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated...
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StartPage 145
SubjectTerms Age
Aging
Data collection
Geriatrics/Gerontology
Hospitals
Illnesses
Internal Medicine
Medicin och hälsovetenskap
Medicine
Medicine & Public Health
Older people
Original Research Article
Patients
Pharmacology/Toxicology
Pharmacotherapy
Polypharmacy
Prescription drugs
Substance abuse treatment
Systematic review
Title Polypharmacy in Home Care in Europe: Cross-Sectional Data from the IBenC Study
URI https://link.springer.com/article/10.1007/s40266-018-0521-y
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