https://orcid.org/0000-0002-9615-1916
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Abstract
Objective
To explore variation in medication regimen complexity in residential aged care facilities (RACFs) according to resident age, length of stay, comorbidity, dementia severity, frailty, and dependence in activities of daily living (ADLs), and compare number of daily administration times and Medication Regimen Complexity Index (MRCI) as measures of regimen complexity.
Methods
This study was a cross-sectional analysis of baseline data from the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial. The SIMPLER study recruited 242 residents with at least one medication charted for regular administration from 8 RACFs in South Australia. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Dementia severity was assessed using the Dementia Severity Rating Scale. Frailty was assessed using the FRAIL-NH scale. Dependence in ADLs was assessed using the Katz ADL scale.
Results
The median age of participants was 87 years (interquartile range 81–92). Over one-third of participants (n=86, 36%) had 5 or more daily medication administration times. The number of daily administration times and MRCI scores were positively correlated with resident length of stay (rs=0.19; 0.27), FRAIL-NH score (rs=0.23; 0.34) and dependence in ADLs (rs=−0.21; −0.33) (all p<0.01). MRCI was weakly negatively correlated with CCI score (rs=−0.16; p=0.013). Neither number of daily administration times nor MRCI score were correlated with age or dementia severity. In multivariate analysis, frailty was associated with number of daily administration times (OR: 1.13, 95% CI: 1.03–1.24) and MRCI score (OR: 1.26, 95% CI: 1.13–1.41). Dementia severity was inversely associated with both multiple medication administration times (OR: 0.97, 95% CI: 0.94–0.99) and high MRCI score (OR: 0.95, 95% CI: 0.92–0.98).
Conclusion
Residents with longer lengths of stay, more dependent in ADLs and most frail had the most complex medication regimens and, therefore, may benefit from targeted strategies to reduce medication regimen complexity.
Acknowledgments
The authors thank the staff and residents of Helping Hand Aged Care for their participation in this study. Thanks also extend to Jessica Bailey, Grace Wan, and Lina Ly for their assistance with data management.
Data Sharing Statement
Final data set access will be limited to study investigators. Other study-related documents, study protocol and model consent form have been previously published and can be accessed at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372482.
Disclosure
This work was supported by the NHMRC Cognitive Decline Partnership Centre (grant number GNT9100000). The Cognitive Decline Partnership Centre receives support from the NHMRC and funding partners including Helping Hand Aged Care, HammondCare, Brightwater and Dementia Australia. The contents of the published materials are solely the responsibility of the individual authors identified, and do not reflect the views of the NHMRC and any other funding bodies or the funding partners. EYHC was supported by a postgraduate research scholarship funded by the Cognitive Decline Partnership Centre and the Monash University Faculty of Pharmacy and Pharmaceutical Sciences. JSB was supported by an NHMRC Dementia Research Leadership Fellowship. MC, MH and JvE are employed by Helping Hand Aged Care. JKS and JI were supported by NHMRC Early Career Fellowships. The authors report no other conflicts of interest in this work.