Relationship of in-hospital medication modifications of elderly patients to postdischarge medications, adherence, and mortality

Ann Pharmacother. 2008 Jun;42(6):783-9. doi: 10.1345/aph.1L070. Epub 2008 Apr 29.


Background: Medication regimens are constantly modified and updated during a patient's hospitalization. These modifications and those made after discharge might increase the risk for nonadherence, polypharmacy, and poor outcomes among elderly patients.

Objectives: To investigate the extent of in-hospital modification of medication regimens of elderly patients and its relationship to medication adherence as well as one-month postdischarge drug regimen modifications and to examine the relationship of the modifications, adherence, and polypharmacy to mortality and readmissions 3 months postdischarge.

Methods: Clinical and demographic data, postdischarge medication modifications, and adherence were prospectively obtained in 212 elderly patients. Inhospital drug regimen modifications were retrospectively recorded.

Results: The average +/- SD in-hospital medication regimen modification rate was 49.8% +/- 28.4. No modifications were found in 9.7% of the patients. Using demographic and clinical parameters, we performed regression analysis and found that patients who were admitted with polypharmacy, discharged home, and cognitively normal experienced fewer medication modifications (p < 0.05). At one month postdischarge, the average medication regimen modification rate was 37.5% +/- 25.4. In- and posthospital modifications were directly correlated (p = 0.047). Three months postdischarge, 17 patients had died and 50 had been readmitted. The independent risk factors for mortality were in-hospital modification rate of 50% or greater (OR 6.4; 95% CI 1.3 to 29.7), impaired cognition (OR 4.2; 95% CI 1.4 to 12.3), and each chronic disease (OR 1.2; 95% CI 1 to 1.5). No relationships were found between in-hospital medication regimen modifications and readmissions or with postdischarge modifications, adherence, and polypharmacy to mortality and readmissions.

Conclusions: Hospitalization of elderly patients is characterized by extensive medication regimen modifications, which are directly correlated with postdischarge modifications and may indicate an increased risk of mortality.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cognition Disorders / complications
  • Drug Utilization / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Hospitalization
  • Humans
  • Israel
  • Male
  • Mortality*
  • Patient Compliance*
  • Patient Discharge*
  • Patient Readmission / statistics & numerical data
  • Pharmaceutical Preparations / administration & dosage*
  • Polypharmacy
  • Prospective Studies
  • Regression Analysis
  • Retrospective Studies
  • Risk Factors


  • Pharmaceutical Preparations