Multimorbidity and polypharmacyin the elderly

Tomasz Grodzicki

Department of Internal Medicine and Geriatrics

Jagiellonian University

Monroe RT. N Engl J Med 1953;249:277-285.

Barnett K, i wsp. Lancet 2012;380(9836):37-43.

Prevalence of chronic diseases in

Scotland

Barnett K, i wsp. Lancet 2012;380(9836):37-43.

Prevalence of chronic diseases in

Scotland

!

Functional limitations ofsubjects with history of

heart failure hospitalisation

Problems with management of

multimorbid patients

Sampalli T, i wsp. Patient Prefer Adherence.2012;6:757-64.

POLSENIOR Results

Polypharmacy in CHF patients :more advanced CHF = more drugs

Cardiovascular drugs:

ACE-I, ARB, Beta-blockers, diuretics, spironolactone, digitalis, ca-blockers, alpha-blockers, other

antihypertensive drugs, nitrates, statins, anticoagulants, antiarrhythmic, antithrombotic, cytoprotective

Adverse Drug Reactions Inpatient Elderly

•Prospective, observational design

ADR in the very elderly (≥80 years old)

Preventability, severity and type of ADR

•560 pts (mean 85 yrs; 63% female)

1 in 8 experienced ADR

Majority serious (69%) some life-threatening(4%)

63% preventable

Tangiisuran et al; J Nutr HealthAgeing.2009

Special Article

Emergency Hospitalizations for Adverse Drug Events in Older Americans

Daniel S. Budnitz, M.D., M.P.H., Maribeth C. Lovegrove, M.P.H., Nadine Shehab, Pharm.D., M.P.H., and Chesley L. Richards, M.D., M.P.H.

N Engl J MedVolume 365(21):2002-2012

November 24, 2011

Rehospitalisations within 30 days in the USA

Jencks SF et al. N Engl J Med 2009;360:1418-1428

Fewer Emergency Readmissions and Better Quality of Life for Older Adults at Risk of

Hospital Readmission:

A Randomized Controlled Trial to Determine the Effectiveness of a

24‐Week Exercise and Telephone Follow‐Up Program

Journal of the American Geriatrics Society Volume 57, Issue 3, pages 395-402, 24 FEB 2009

From: The Care Transitions Intervention: Results of

a Randomized Controlled Trial

Arch Intern Med. 2006;166(17):1822-1828. doi:10.1001/archinte.166.17.1822

Care Transitions Intervention Activities by Pillar and by Stage of Intervention

The Care Transitions Intervention: Results of

a Randomized Controlled Trial

Arch Intern Med. 2006;166(17):1822-1828. doi:10.1001/archinte.166.17.1822

Costs

Rehosptalizations

Special Article

Readmissions, Observation, and the Hospital Readmissions Reduction Program

Rachael B. Zuckerman, M.P.H., Steven H. Sheingold, Ph.D., E. John Orav, Ph.D., Joel Ruhter, M.P.P., M.H.S.A., and Arnold M. Epstein, M.D.

N Engl J MedVolume 374(16):1543-1551

April 21, 2016

Study Overview

• The ACA Hospital Readmissions Reduction Program applies penalties for high readmission rates.

• Among Medicare beneficiaries, rates declined after the ACA went into effect.

• There was no significant association between changes in observation stays and readmissions.

Change in Readmission Rates for Targeted Conditions and Nontargeted Conditions within 30 Days after Discharge.

Zuckerman RB et al. N Engl J Med 2016;374:1543-1551

Caregivers!

Caregiving as a Risk Factor for Mortality: The Caregiver Health Effects Study

JAMA. 1999;282(23):2215-2219. doi:10.1001/jama.282.23.2215

After adjusting for sociodemographic factors (age, sex, race, education, stressful life events) and physical health status (prevalent disease and subclinical disease), participants who were providing care and experiencing caregiver strain had mortality risks that were 63% higher than those whose spouse was not disabled (RR, 1.63; 95% confidence interval [CI], 1.00-2.65).