Medication Regimen Complexity in Institutionalized Elderly People in an Aging Society

Overview

Journal Int J Clin Pharm

Publisher Springer

Specialties Pharmacology
Pharmacy

Date 2014 Jun 8

PMID 24906719

Citations 27

Authors

Ana Margarida Advinha

Sofia de Oliveira-Martins

Vanessa Mateus

Sara Grou Pajote

Manuel Jose Lopes

Affiliations

Soon will be listed here.

Abstract

Background: Complex medication regimens may adversely affect compliance and treatment outcomes. Complexity can be assessed with the medication regimen complexity index (MRCI), which has proved to be a valid, reliable tool, with potential uses in both practice and research.

Objective: To use the MRCI to assess medication regimen complexity in institutionalized elderly people.

Setting: Five nursing homes in mainland Portugal.

Methods: A descriptive, cross-sectional study of institutionalized elderly people (n = 415) was performed from March to June 2009, including all inpatients aged 65 and over taking at least one medication per day.

Main Outcome Measure: Medication regimen complexity index.

Results: The mean age of the sample was 83.9 years (±6.6 years), and 60.2 % were women. The elderly patients were taking a large number of drugs, with 76.6 % taking more than five medications per day. The average medication regimen complexity was 18.2 (±SD = 9.6), and was higher in the females (p < 0.001). The most decisive factors contributing to the complexity were the number of drugs and dosage frequency. In regimens with the same number of medications, schedule was the most relevant factor in the final score (r = 0.922), followed by pharmaceutical forms (r = 0.768) and additional instructions (r = 0.742).

Conclusion: Medication regimen complexity proved to be high. There is certainly potential for the pharmacist's intervention to reduce it as part as the medication review routine in all the patients.

Citing Articles

Inappropriate medication prescribing, polypharmacy, potential drug-drug interactions and medication regimen complexity in older adults attending three referral hospitals in Asmara, Eritrea: a cross-sectional study.

Abdu N, Idrisnur S, Said H, Kifle L, Habte N, Ghirmai S BMC Geriatr. 2025; 25(1):76.

PMID: 39901132 PMC: 11789384. DOI: 10.1186/s12877-025-05736-9.

Statement on medication simplification in long-term care facilities by the Japanese Society of Geriatric Pharmacy: English translation of the Japanese article.

Maruoka H, Hamada S, Koujiya E, Higashihara K, Shinonaga H, Arai K Geriatr Gerontol Int. 2024; 25(1):14-24.

PMID: 39632561 PMC: 11711068. DOI: 10.1111/ggi.15009.

Complexity of the Therapeutic Regimen in Older Adults with Cancer: Associated Factors.

Oliveira R, Oliveira A, Cruz A, Ribeiro O, Afreixo V, Pimentel F Pharmaceuticals (Basel). 2024; 17(11).

PMID: 39598449 PMC: 11597645. DOI: 10.3390/ph17111541.

A Prospective Study of the Medication Regimen Complexity Index and Hospitalization Due to Adverse Drug Reactions Among People Living with HIV.

Poojar B, Kamath A, Rao S, Ullal S, Ramapuram J, Yadiyal M Medicina (Kaunas). 2024; 60(10).

PMID: 39459492 PMC: 11509384. DOI: 10.3390/medicina60101705.

Potentially Inappropriate Medication: A Pilot Study in Institutionalized Older Adults.

Andrade A, Nascimento T, Cabrita C, Leitao H, Pinto E Healthcare (Basel). 2024; 12(13).

PMID: 38998810 PMC: 11241476. DOI: 10.3390/healthcare12131275.

References

Chaimowicz F, Greco D . [Dynamics of institutionalization of older adults in Belo Horizonte, Brazil]. Rev Saude Publica. 1999; 33(5):454-60. DOI: 10.1590/s0034-89101999000500004. View

Mannesse C, Derkx F, de Ridder M, Man in t Veld A, van der Cammen T . Adverse drug reactions in elderly patients as contributing factor for hospital admission: cross sectional study. BMJ. 1997; 315(7115):1057-8. PMC: 2127685. DOI: 10.1136/bmj.315.7115.1057. View

de Oliveira Martins S, Soares M, van Mil J, Cabrita J . Inappropriate drug use by Portuguese elderly outpatients--effect of the Beers criteria update. Pharm World Sci. 2006; 28(5):296-301. DOI: 10.1007/s11096-006-9046-2. View

Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson P, Carpenter I . Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005; 293(11):1348-58. DOI: 10.1001/jama.293.11.1348. View

Elliott R . Reducing medication regimen complexity for older patients prior to discharge from hospital: feasibility and barriers. J Clin Pharm Ther. 2012; 37(6):637-42. DOI: 10.1111/j.1365-2710.2012.01356.x. View

S Ingersoll K, Cohen J . The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008; 31(3):213-24. PMC: 2868342. DOI: 10.1007/s10865-007-9147-y. View

Hanlon J, Schmader K, Ruby C, Weinberger M . Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc. 2001; 49(2):200-9. DOI: 10.1046/j.1532-5415.2001.49042.x. View

Stange D, Kriston L, von-Wolff A, Baehr M, Dartsch D . Reducing cardiovascular medication complexity in a German university hospital: effects of a structured pharmaceutical management intervention on adherence. J Manag Care Pharm. 2013; 19(5):396-407. PMC: 10437592. DOI: 10.18553/jmcp.2013.19.5.396. View

Murray M, Callahan C . Improving medication use for older adults: an integrated research agenda. Ann Intern Med. 2003; 139(5 Pt 2):425-9. DOI: 10.7326/0003-4819-139-5_part_2-200309021-00009. View

10.

McDonald M, Peng T, Sridharan S, Foust J, Kogan P, Pezzin L . Automating the medication regimen complexity index. J Am Med Inform Assoc. 2012; 20(3):499-505. PMC: 3628060. DOI: 10.1136/amiajnl-2012-001272. View

11.

Mosegui G, Rozenfeld S, Veras R, Vianna C . [Quality assessment of drug use in the elderly]. Rev Saude Publica. 1999; 33(5):437-44. DOI: 10.1590/s0034-89101999000500002. View

12.

Muir A, Sanders L, WILKINSON W, Schmader K . Reducing medication regimen complexity: a controlled trial. J Gen Intern Med. 2001; 16(2):77-82. PMC: 1495168. DOI: 10.1046/j.1525-1497.2001.016002077.x. View

13.

Hanlon J, Artz M, Pieper C, Lindblad C, Sloane R, Ruby C . Inappropriate medication use among frail elderly inpatients. Ann Pharmacother. 2004; 38(1):9-14. DOI: 10.1345/aph.1D313. View

14.

George J, Phun Y, Bailey M, Kong D, Stewart K . Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004; 38(9):1369-76. DOI: 10.1345/aph.1D479. View

15.

Castellar J, Karnikowski M, Vianna L, Nobrega O . [Study of the pharmacotherapy prescribed for older-adult in a Brazilian long-term care facility]. Acta Med Port. 2007; 20(2):97-105. View

16.

Correr C, Melchiors A, Fernandez-Llimos F, Pontarolo R . Effects of a pharmacotherapy follow-up in community pharmacies on type 2 diabetes patients in Brazil. Int J Clin Pharm. 2011; 33(2):273-80. DOI: 10.1007/s11096-011-9493-2. View

17.

Corsonello A, Pedone C, Lattanzio F, Lucchetti M, Garasto S, Carbone C . Regimen complexity and medication nonadherence in elderly patients. Ther Clin Risk Manag. 2009; 5(1):209-16. PMC: 2697531. DOI: 10.2147/tcrm.s4870. View

18.

Bushardt R, Massey E, Simpson T, Ariail J, Simpson K . Polypharmacy: misleading, but manageable. Clin Interv Aging. 2008; 3(2):383-9. PMC: 2546482. DOI: 10.2147/cia.s2468. View

19.

Kaufman D, Kelly J, Rosenberg L, Anderson T, Mitchell A . Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA. 2002; 287(3):337-44. DOI: 10.1001/jama.287.3.337. View

20.

Sicras-Mainar A, de Cambra-Florensa S, Navarro-Artieda R . [Consumption of oral analgesics and dosage forms in elderly patients: population-based study]. Farm Hosp. 2009; 33(3):161-71. View