Hubbard Center for Nursing Research on Aging, University of Rochester, School of Nursing, Rochester, NY, USA.
University of Rochester Medical Center, Department of Medicine, Rochester, NY, USA.
J Am Med Dir Assoc. 2022 Oct;23(10):1627-1633.e3. doi: 10.1016/j.jamda.2022.03.012. Epub 2022 Apr 28.
Polypharmacy is common in home health care (HHC). This study examined the prevalence of medications associated with geriatric syndromes (MAGS), its predictors, and association with subsequent hospitalization in HHC.
Analysis of HHC electronic medical records, the Outcome and Assessment Information Set (OASIS), and Medicare HHC claims.
A total of 6882 adults ≥65 years old receiving HHC in 2019 from a large, not-for-profit home health agency serving multiple counties in New York State.
MAGS use was identified from active medications reconciled during HHC visits (HHC electronic medical records). MAGS use was operationalized as count and in quartiles. Hospitalization during the HHC episode was operationalized as a time-to-event variable (ie, number of days from HHC admission to hospitalization). We used regression analyses to identify predictors of MAGS use, and survival analyses to examine the association between MAGS and hospitalization.
Nearly all (98%) of the HHC patients used at least 1 MAGS and 41% of all active medications used by the sample were MAGS. More MAGS use was found in HHC patients who were community-referred, taking more medications, and having more diagnoses, depressive symptoms, and functional limitations. Adjusted for covariates, higher MAGS quartiles were not independently associated with the risk of hospitalization, but higher MAGS quartiles combined with multimorbidity (ie, having ≥10 diagnoses) were associated with a 2.3-fold increase in hospitalization risk (hazard ratio 2.24; 95% confidence interval: 1.61-3.13; P < .001), relative to the lowest quartile of MAGS use and having <10 diagnoses.
More than 40% of medications taken by HHC patients are MAGS. Multimorbidity and MAGS use collectively increased the risk of hospitalization by up to 2.3 times. HHC clinicians should carefully review patients' medications and use information about MAGS to facilitate discussion about deprescribing with patients and their prescribers.
多药治疗在家庭保健护理（HHC）中很常见。本研究调查了与老年综合征相关的药物（MAGS）的流行程度、其预测因素以及与 HHC 后续住院的关联。
对 HHC 电子病历、Outcome and Assessment Information Set（OASIS）和 Medicare HHC 索赔进行分析。
2019 年，来自一家为纽约州多个县提供服务的大型非营利性家庭保健机构的 6882 名年龄在 65 岁及以上的成年人接受了 HHC。
通过在 HHC 就诊期间（HHC 电子病历）进行的活跃药物 reconciled 来识别 MAGS 的使用情况。MAGS 使用被操作化为计数和四分位。HHC 期间的住院治疗被操作化为时间事件变量（即，从 HHC 入院到住院的天数）。我们使用回归分析来确定 MAGS 使用的预测因素，并使用生存分析来检查 MAGS 与住院之间的关联。
几乎所有（98%）HHC 患者都至少使用了一种 MAGS，样本中使用的所有活性药物中有 41%是 MAGS。在社区转介、服用更多药物和有更多诊断、抑郁症状和功能限制的 HHC 患者中，MAGS 的使用更多。调整协变量后，较高的 MAGS 四分位数与住院风险无独立关联，但较高的 MAGS 四分位数与合并多病（即，有≥10 个诊断）与住院风险增加 2.3 倍相关（危险比 2.24；95%置信区间：1.61-3.13；P<.001），与使用最低 MAGS 四分位数和<10 个诊断相比。
HHC 患者服用的药物中，有超过 40%是 MAGS。多病和 MAGS 使用共同使住院风险增加了 2.3 倍。HHC 临床医生应仔细审查患者的药物并使用有关 MAGS 的信息，以便与患者及其处方医生讨论减少用药。
