A multi-centre cohort study on healthcare use due to medication-related harm: the role of frailty and polypharmacy

Jennifer M Stevenson; Nikesh Parekh; Kia-Chong Chua; J Graham Davies; Rebekah Schiff; Chakravarthi Rajkumar; Khalid Ali

doi:10.1093/ageing/afac054

A multi-centre cohort study on healthcare use due to medication-related harm: the role of frailty and polypharmacy

Age Ageing. 2022 Mar 1;51(3):afac054. doi: 10.1093/ageing/afac054.

Authors

Jennifer M Stevenson^{1

2}, Nikesh Parekh^{3

4}, Kia-Chong Chua⁵, J Graham Davies^{1

6}, Rebekah Schiff⁷, Chakravarthi Rajkumar^{8

9}, Khalid Ali^{8

9}

Affiliations

¹ Medicines Use Research Group, Institute of Pharmaceutical Science, King's College London, London, UK.
² Pharmacy Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
³ Seaford Medical Practice, Seaford, UK.
⁴ Public Health and Wellbeing, Royal Borough of Greenwich, London, UK.
⁵ Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁶ School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK.
⁷ Department of Ageing and Health, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
⁸ Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, UK.
⁹ Department of Geriatrics, University Hospitals Sussex NHS Foundation Trust, Sussex, UK.

Abstract

Objectives: To determine the association between frailty and medication-related harm requiring healthcare utilisation.

Design: Prospective observational cohort study.

Setting: Six primary and five secondary care sites across South East England, September 2013-November 2015.

Participants: One thousand and two hundred and eighty participants, ≥65 years old, who were due for discharge from general medicine and older persons' wards following an acute episode of care. Exclusion criteria were limited life expectancy, transfer to another hospital and consent not gained.

Main outcome measures: Medication-related harm requiring healthcare utilisation (including primary, secondary or tertiary care consultations related to MRH), including adverse drug reactions, non-adherence and medication error determined via the review of data from three sources: patient/carer reports gathered through a structured telephone interview; primary care medical record review; and prospective consultant-led review of readmission to recruiting hospital. Frailty was measured using a Frailty Index, developed using a standardised approach. Marginal estimates were obtained from logistic regression models to examine how probabilities of healthcare service use due to medication-related harm were associated with increasing number of medicines and frailty.

Results: Healthcare utilisation due to medication-related harm was significantly associated with frailty (OR = 10.06, 95% CI 2.06-49.26, P = 0.004), independent of age, gender, and number of medicines. With increasing frailty, the need for healthcare use as a result of MRH increases from a probability of around 0.2-0.4. This is also the case for the number of medicines.

Conclusions: Frailty is associated with MRH, independent of polypharmacy. Reducing the burden of frailty through an integrated health and social care approach, alongside strategies to reduce inappropriate polypharmacy, may reduce MRH related healthcare utilisation.

Keywords: adverse drug reactions; aged; frailty; non-adherence; older people; risk stratification.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cohort Studies
Frailty* / diagnosis
Frailty* / epidemiology
Humans
Patient Discharge
Polypharmacy*
Prospective Studies

Grants and funding

PB-PG-0711-25,094/DH_/Department of Health/United Kingdom