Post-discharge adjustment of medication in geriatric patients
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Gerontologie+Geriatrie Original Contributions Z Gerontol Geriat https://doi.org/10.1007/s00391-019-01601-8 Received: 21 May 2019 Accepted: 5 August 2019 © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019
Olaf Krause1,2 · Stefanie Glaubitz2,3 · Klaus Hager1 · Tanja Schleef2 · Birgitt Wiese2 · Ulrike Junius-Walker2 1
Center for Medicine of the Elderly, DIAKOVERE Henriettenstift, Hannover, Germany Institute for General Practice, Hannover Medical School, Hannover, Germany 3 Department of Neurology, University Medical Center Göttingen, Göttingen, Germany 2
Post-discharge adjustment of medication in geriatric patients A prospective cohort study Introduction Hospital discharge is a critical phase in patient care due to the transition from one healthcare setting to another. This is especially true for the therapeutic interventions in older patients suffering from multimorbidity. They often present with a high prevalence of polypharmacy (PP) and potentially inappropriate medications (PIM). Geriatric units in hospitals are aware of these medication-related risks and use decision support tools to assist in safe prescription, e.g. START criteria [20] or the FORTA list [16]; however, studies have shown that medication issues particularly arise in the discharge phase. A variety of factors have been made responsible, such as reconciliation errors, mismatch of dosages, non-adherence and confusing substitutions [18, 25]. Moreover, patients are often not aware of medication changes, have little knowledge about the discharge medication [5] and are confronted with unfamiliar routines in handling new medications [7]. Delays in issuing discharge letters with the medication charts seem to contribute towards re-hospitalization [27]. Hence the medication transition phase after discharge seems to pose a significant risk for older patients, often contributing to deteriorating illnesses and impaired health outcomes [25]. Despite the observed issues in the medication management of older patients and the inherent risks of adverse drug events post-discharge [15], few studies have sought descriptive evidence on the medication changes that occur in
this transitional phase. In a prospective study focusing on the post-discharge period, only 16% of the geriatric patients remained on the hospital prescriptions after 1 month. A third of all medications had been modified [18]. Likewise, a Danish study demonstrated that 64% of the drugs from a geriatric hospital were continued by primary care doctors. The acceptance rate was somewhat lower for the newly initiated medications during hospital stay [17]. In another study initiated on general medical wards, it was observed that the number of drugs increased during hospital stay from an average of 5.6 to 7.6 medications. General practitioners (GP) altered the discharge medication charts for 86% of patients in the 4–5 month follow-up period. Only every fourth discharge letter had arrived timely within 1 week [28]. With the complexity of medication management of older geriatric patients in mind,
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