Most Older Patients Can Manage Drugs After Hospital Discharge, Study Finds

However, letting nurses have total control of medication management during hospital stays can create problems afterward.

Most geriatric patients can successfully self-manage multiple medications after being discharged from the hospital, according to a multicenter study published in the International Journal of Environmental Research and Public Health.

At the same time, many patients struggle with medication management immediately after discharge, and one of the strongest predictors is whether the nursing staff took control of medication management during their hospital stay.

The multicenter study collected data on 400 patients at hospital discharge and at 2-5 days post-discharge between November 2019 and March 2020. All patients involved were at least 75 years old and dealing with polypharmacy, which was defined as taking at least 5 medications at the same time. Another 69 patients were eligible but did not participate.

The patients were questioned about medication management using a combination of validated and self-developed questionnaires. Of 400 participants who had been admitted in 12 hospitals in Flanders, Belgium, 70% successfully self-managed medication post-discharge.

The study aimed to describe post discharge medication self-management, in which the patient completes a set of actions to manage medications, and to describe the problems encountered with polypharmacy and to determine the related factors.

Before hospitalization, approximately 78% of patients fully self-managed their medications. During hospitalization, this number dropped to 13% while 74% of patients had nursing staff that managed their medications. Among that 13%, all patients received assistance in preparing their medications but administered them independently. Post discharge, 70% fully self-managed their mediations, 27% received assistance with preparing their medications but self-administered, and 3% received assistance with both preparing and administering their medications at home.

According to the authors, although 70% represents a high share of older patients able to manage their medications, it still leaves a large group struggling at the beginning the self-management process.

The self-management process begins with getting a prescription filled and picked up, and the study showed that many patients already experienced problems at this stage. Some reasons include not having the required prescriptions, not knowing who to contact, and not having the resources to obtain their prescribed medicines.

“Being unable to obtain medication jeopardizes the entire medication self-management process,” the authors said. “Therefore, prior to hospital discharge, healthcare providers should assess if patients are able to obtain their medicines and if they can rely on (in)formal caregivers to purchase medication.”

Beyond this, the most common problem was patients not having adequate knowledge and understanding of their medications; 86% experienced at least 1 knowledge-related deficiency during post discharge. About three-quarters of the patients did not know the name or dosage of all of their prescriptions, and about two-thirds did not know the indication of all of their medications after hospital discharge.

The study concluded that medication management by nursing staff during hospitalization was a significant predictor of deficiencies. Nurses took over the patient’s medication management in 74% of cases, therefore disrupting the continuity of self-management in patients who were self-managing their medications before hospitalization.

“In daily practice, allowing more patients to self-manage medication during their hospital stay might be beneficial,” the authors stated.

There was also a link between medication self-management and medication adherence. In one study, a significant proportion of geriatric patients both intentionally and non-intentionally did not take or stopped taking their medications.

A major reason for intentional non-adherence was side effects. Reasons for non-intentional non-adherence included forgetting to take medications, being physically unable to take the medications, and taking medications at the wrong time or in incorrect doses.

Overall, the multicenter study found that geriatric patients are not given adequate instruction on medication self-management after hospital discharge.

“During hospitalization, healthcare providers should identify and address medication self-management issues,” the authors concluded. “To prevent problems after hospital discharge, in-hospital preparation should be improved to support medication self-management at home.”

Reference

Mortelmans L, De Baetselier E, Goossens E, Dilles T. What happens after hospital discharge? deficiencies in medication management encountered by geriatric patients with polypharmacy. Int J Environ Res Public Health. Published online June 30, 2021. doi:10.3390/ijerph18137031