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Letter to the Editor| Volume 22, ISSUE 2, P470-471, February 2021

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What is the Best Definition of Polypharmacy for Predicting Falls, Hospitalizations, and Mortality in Long-Term Care Facilities?

  • Kate N. Wang
    Affiliations
    Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
    School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
    Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
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  • Edwin C.K. Tan
    Affiliations
    Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
    Aging Research Center, Department of Neurobiology Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
    The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, New South Wales, Australia
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  • Jenni Ilomäki
    Affiliations
    Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
    Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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  • Julia F.M. Gilmartin-Thomas
    Affiliations
    Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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  • Janet K. Sluggett
    Affiliations
    Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
    University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
    NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
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  • Tina Cooper
    Affiliations
    Resthaven Incorporated, Adelaide, South Australia, Australia
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  • Leonie Robson
    Affiliations
    Resthaven Incorporated, Adelaide, South Australia, Australia
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  • J. Simon Bell
    Affiliations
    Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
    Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
    NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
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Published:November 24, 2020DOI:https://doi.org/10.1016/j.jamda.2020.10.040
What is the Best Definition of Polypharmacy for Predicting Falls, Hospitalizations, and Mortality in Long-Term Care Facilities?
Previous ArticleThe Characteristics of Physicians Who Primarily Practice in Nursing Homes
Next ArticleHealth Care Needs in Assisted Living: Survey Data May Underestimate Chronic Conditions
      Residents of long-term care facilities (LTCFs) are often exposed to polypharmacy.
      • Jokanovic N.
      • Tan E.C.
      • Dooley M.J.
      • et al.
      Why is polypharmacy increasing in aged care facilities? The views of Australian health care professionals.
      J Eval Clin Pract. 2016; 22: 677-682
      There is a possible association between polypharmacy and falls, hospitalizations, and mortality.
      • Onder G.
      • Liperoti R.
      • Foebel A.
      • et al.
      Polypharmacy and mortality among nursing home residents with advanced cognitive impairment: Results from the SHELTER study.
      J Am Med Dir Assoc. 2013; 14 (e457‒412): 450
      ,
      • Wang K.N.
      • Bell J.S.
      • Chen E.Y.H.
      • et al.
      Medications and prescribing patterns as factors associated with hospitalizations from long-term care facilities: A systematic review.
      Drugs Aging. 2018; 35: 423-457
      Polypharmacy definition ranges between the use of more than 2 to 11 medications.
      • Masnoon N.
      • Shakib S.
      • Kalisch-Ellett L.
      • Caughey G.E.
      What is polypharmacy? A systematic review of definitions.
      BMC Geriatr. 2017; 17: 230
      The definition “9 or more regular medications” is the most common in LTCFs.
      • Jokanovic N.
      • Tan E.C.K.
      • Dooley M.J.
      • et al.
      Prevalence and factors associated with polypharmacy in long-term care facilities: A systematic review.
      J Am Med Dir Assoc. 2015; 16 (e531‒535.e512): 535
      Lack of a standard definition limits comparison of polypharmacy rates and adverse events. This study investigated evidence for an optimal cut-point to define polypharmacy in LTCFs to predict falls, hospitalizations, and mortality.
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      References

        • Jokanovic N.
        • Tan E.C.
        • Dooley M.J.
        • et al.
        Why is polypharmacy increasing in aged care facilities? The views of Australian health care professionals.
        J Eval Clin Pract. 2016; 22: 677-682
        View in Article
        • Onder G.
        • Liperoti R.
        • Foebel A.
        • et al.
        Polypharmacy and mortality among nursing home residents with advanced cognitive impairment: Results from the SHELTER study.
        J Am Med Dir Assoc. 2013; 14 (e457‒412): 450
        View in Article
        • Wang K.N.
        • Bell J.S.
        • Chen E.Y.H.
        • et al.
        Medications and prescribing patterns as factors associated with hospitalizations from long-term care facilities: A systematic review.
        Drugs Aging. 2018; 35: 423-457
        View in Article
        • Masnoon N.
        • Shakib S.
        • Kalisch-Ellett L.
        • Caughey G.E.
        What is polypharmacy? A systematic review of definitions.
        BMC Geriatr. 2017; 17: 230
        View in Article
        • Jokanovic N.
        • Tan E.C.K.
        • Dooley M.J.
        • et al.
        Prevalence and factors associated with polypharmacy in long-term care facilities: A systematic review.
        J Am Med Dir Assoc. 2015; 16 (e531‒535.e512): 535
        View in Article
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        View in Article

      Article info

      Publication history

      Published online: November 24, 2020

      Footnotes

      This work was supported by the Alzheimer Australia Dementia Research Foundation via the Resthaven Incorporated Dementia Research Award, with additional funding provided by Resthaven Incorporated. KW is supported through an Australian Government Research Training Program Scholarship. ET and JG-T are National Health and Medical Research Council (NHMRC)-Australian Research Council (ARC) Dementia Research Development Fellows (APP1107476 and APP1107381). JI is supported by a NHMRC Early Career Research Fellowship (#1072137). JKS is supported by a NHMRC Early Career Fellowship (APP1156439). JSB is supported by a NHMRC Dementia Leadership Fellowship (#1140298). TC and LR are current employees of Resthaven Incorporated.

      All authors declare no other conflict of interest.

      Identification

      DOI: https://doi.org/10.1016/j.jamda.2020.10.040

      Copyright

      © 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

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