Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Am Surg. 2023 Nov;89(11):4438-4444. doi: 10.1177/00031348221083958. Epub 2022 Jul 16.
Hospitalization for the older trauma patient is an opportunity to assess polypharmacy. We hypothesized that medication regimen complexity (RxCS) and pain medication prescriptions (PRxs) would increase in older home-going patients admitted for a fall.
We retrospectively chart reviewed patients ≥45 years old admitted for a fall at a level 1 trauma center who were discharged home with full medication documentation. RxCS was compared pre-admission and post-discharge with Wilcoxon signed-rank tests; opioid and non-opioid PRxs were compared with Fisher's exact test, α = .05.
103 patients met inclusion criteria; 58% were ≥65 years old. RxCS (9 [.5-13] to 11 [4.5-15], < .01) increased on discharge. Opioid PRx rates increased significantly in all age groups. Non-opioid PRx rates increased significantly for patients <65 but not for patients ≥65.
Admission for a fall was associated with increases in RxCS, while PRx changes were age-dependent. Providers should recognize that admissions for older patients who fall after trauma are underutilized opportunities to address polypharmacy in high-risk patients.
老年创伤患者住院是评估多种药物治疗的机会。我们假设，在因跌倒而住院的老年出院患者中，药物治疗方案的复杂性（RxCS）和疼痛药物处方（PRxs）会增加。
我们回顾性地对在一级创伤中心因跌倒而住院且出院时具有完整药物记录的≥45 岁患者进行了图表审查。使用 Wilcoxon 符号秩检验比较入院前和出院后的 RxCS；使用 Fisher 确切检验比较阿片类药物和非阿片类药物 PRxs，α=0.05。
符合纳入标准的 103 名患者中，58%的患者年龄≥65 岁。出院时 RxCS（9[0.5-13]至 11[4.5-15]，<0.01）增加。所有年龄段的阿片类药物 PRx 率均显著增加。非阿片类药物 PRx 率在<65 岁的患者中显著增加，但在≥65 岁的患者中则没有增加。
因跌倒而入院与 RxCS 的增加有关，而 PRx 的变化则与年龄有关。提供者应认识到，对于因创伤后跌倒而住院的老年患者，入院是一个利用不足的机会，可以解决高危患者的多种药物治疗问题。
