Association between clusters of diseases and polypharmacy in hospitalized elderly patients: Results from the REPOSI study

Alessandro Nobili, Alessandra Marengoni, Mauro Tettamanti, Francesco Salerno, Luca Pasina, Carlotta Franchi, Alfonso Iorio, Maura Marcucci, Salvatore Corrao, Giuseppe Licata, Pier Mannuccio Mannucci

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Abstract

AbstractBackground Although the association between multimorbidity and polypharmacy has been clearly documented, no study has analyzed whether or not specific combinations of diseases influence the prescription of polypharmacy in older persons. We assessed which clusters of diseases are associated with polypharmacy in acute-care elderly in-patients. Methods This cross-sectional study was held in 38 Italian internal medicine and geriatric wards participating in the Registro Politerapie SIMI (REPOSI) study during 2008. The study sample included 1155 in-patients aged 65 years or older. Clusters of diseases, defined as two or more co-occurring specific chronic diseases, were identified using the odds ratio (OR) for the associations between pairs of diseases followed by cluster analysis. Polypharmacy was defined as the prescription of five or more different medications at hospital discharge. Logistic regression models were run to analyze the association between clusters of diseases and polypharmacy. Results Among clusters of diseases, the highest mean number of drugs (> 8) was found in patients affected by heart failure (HF) plus chronic obstructive pulmonary disease (COPD), HF plus chronic renal failure (CRF), COPD plus coronary heart disease (CHD), diabetes mellitus plus CRF, and diabetes mellitus plus CHD plus cerebrovascular disease (CVD). The strongest association between clusters of diseases and polypharmacy was found for diabetes mellitus plus CHD plus CVD, diabetes plus CHD, and HF plus atrial fibrillation (AF). Conclusions The observed knowledge of the relationship among co-occurring diseases and polypharmacy should help to identify and monitor older in-patients at risk of polypharmacy.

Original languageEnglish
Pages (from-to)597-602
Number of pages6
JournalEuropean Journal of Internal Medicine
Volume22
Issue number6
DOIs
Publication statusPublished - Dec 2011

Fingerprint

Polypharmacy
Coronary Disease
Cerebrovascular Disorders
Diabetes Mellitus
Heart Failure
Chronic Obstructive Pulmonary Disease
Chronic Kidney Failure
Prescriptions
Logistic Models
Internal Medicine
Geriatrics
Atrial Fibrillation
Cluster Analysis
Comorbidity
Chronic Disease
Cross-Sectional Studies
Odds Ratio

Keywords

  • Cluster of diseases
  • Hospitalized elderly
  • Polypharmacy

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Association between clusters of diseases and polypharmacy in hospitalized elderly patients : Results from the REPOSI study. / Nobili, Alessandro; Marengoni, Alessandra; Tettamanti, Mauro; Salerno, Francesco; Pasina, Luca; Franchi, Carlotta; Iorio, Alfonso; Marcucci, Maura; Corrao, Salvatore; Licata, Giuseppe; Mannucci, Pier Mannuccio.

In: European Journal of Internal Medicine, Vol. 22, No. 6, 12.2011, p. 597-602.

Research output: Contribution to journalArticle

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T1 - Association between clusters of diseases and polypharmacy in hospitalized elderly patients

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AU - Nobili, Alessandro

AU - Marengoni, Alessandra

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AU - Salerno, Francesco

AU - Pasina, Luca

AU - Franchi, Carlotta

AU - Iorio, Alfonso

AU - Marcucci, Maura

AU - Corrao, Salvatore

AU - Licata, Giuseppe

AU - Mannucci, Pier Mannuccio

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N2 - AbstractBackground Although the association between multimorbidity and polypharmacy has been clearly documented, no study has analyzed whether or not specific combinations of diseases influence the prescription of polypharmacy in older persons. We assessed which clusters of diseases are associated with polypharmacy in acute-care elderly in-patients. Methods This cross-sectional study was held in 38 Italian internal medicine and geriatric wards participating in the Registro Politerapie SIMI (REPOSI) study during 2008. The study sample included 1155 in-patients aged 65 years or older. Clusters of diseases, defined as two or more co-occurring specific chronic diseases, were identified using the odds ratio (OR) for the associations between pairs of diseases followed by cluster analysis. Polypharmacy was defined as the prescription of five or more different medications at hospital discharge. Logistic regression models were run to analyze the association between clusters of diseases and polypharmacy. Results Among clusters of diseases, the highest mean number of drugs (> 8) was found in patients affected by heart failure (HF) plus chronic obstructive pulmonary disease (COPD), HF plus chronic renal failure (CRF), COPD plus coronary heart disease (CHD), diabetes mellitus plus CRF, and diabetes mellitus plus CHD plus cerebrovascular disease (CVD). The strongest association between clusters of diseases and polypharmacy was found for diabetes mellitus plus CHD plus CVD, diabetes plus CHD, and HF plus atrial fibrillation (AF). Conclusions The observed knowledge of the relationship among co-occurring diseases and polypharmacy should help to identify and monitor older in-patients at risk of polypharmacy.

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