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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).
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