Medication Regimen Complexity In 8 Australian Residential Aged Care Facilities: Impact Of Age, Length Of Stay, Comorbidity, Frailty, And Dependence In Activities Of Daily Living

Figures & data

Figure 1 Study recruitment flow diagram.

Abbreviation: RACFs, residential aged care facilities.

Table 1 Baseline Characteristics Of SIMPLER Participants

Characteristic Median (Interquartile Range) Unless Specified	Total n=242
Age in years	87 (81–92)
Female; n (%)	179 (74%)
Rural; n (%)	48 (20%)
Length of stay in the residential aged care facility (RACF) in years	2.5 (1.0–4.7)
Charlson Comorbidity Index (CCI) score^a	2 (2–3)
Documented dementia diagnosis; n (%)	131 (54%)
Dementia Severity Rating Scale (DSRS) score^b,c	21 (11.8–38.3)
Frailty in Nursing Homes (FRAIL-NH) score^b,d	7 (3–10)
Katz Index of Independence in Activities of Daily Living (Katz-ADL)^b,e,f	1 (1–3)
Number of charted medications	13 (9–17)
Regular	9 (6–12)
Pro re nata (PRN)	4 (2–7)
Most prevalent medications charted (ATC code); n (% of residents)
Paracetamol (N02BE01)	224 (93%)
Docusate with sennosides (A06AB56)	145 (60%)
Macrogol (A06AD15)	103 (43%)
Colecalciferol (A11CC05)	85 (35%)
Furosemide (C03CA01)	76 (31%)
Number of medication administration times per day	4 (3–5)
Medication Regimen Complexity Index (MRCI) score	42 (28.5–55.5)
Section A score (formulation)	9 (5–13)
Section B score (frequency)	19.8 (14–26)
Section C score (special instructions for administration)	11 (7–17)

Notes: ^aPossible range: 0–24, 0=none of the Charlson comorbidities. ^bMissing for n=2. ^cPossible range: 0–54 (mild impairment, 0–18; moderate impairment, 19–36; severe impairment, 37–54). ^dPossible range: 0–14 (non-frail, 0–1; frail, 2–5; most frail, 6–14). ^ePossible range: 0–6 (dependence in all domains, 0; independence in all domains, 6). ^fWhen reversed to score for dependence: 5 (3–5).

Abbreviation: ATC, Anatomical Therapeutic Chemical.

Figure 2 Scatter plot of Medication Regimen Complexity Index (MRCI) score versus daily administration times with linear regression lines.

Figure 3 Plots of correlation of daily administration times with (A) age, (B) length of stay, (C) Charlson Comorbidity Index (CCI) score, (D) Dementia Severity Rating Scale (DSRS) score, (E) Frailty in Nursing Homes (FRAIL-NH) score, and (F) Katz Index of Independence in Activities of Daily Living (Katz-ADL) score, reversed to score for dependence. Solid lines: linear regression line; shaded areas: 95% confidence intervals. *Missing for n=2.

Figure 4 Plots of correlation of Medication Regimen Complexity Index (MRCI) score with (A) age, (B) length of stay, (C) Charlson Comorbidity Index (CCI) score, (D) Dementia Severity Rating Scale (DSRS) score, (E) Frailty in Nursing Homes (FRAIL-NH) score, and (F) Katz Index of Independence in Activities of Daily Living (Katz-ADL) score, reversed to score for dependence. Solid lines: linear regression line; shaded areas: 95% confidence intervals. *Missing for n=2.

Table 2 Univariate And Multivariate Logistic Regression Analysis

	Multiple Medication Administration Times		High MRCI Score
	Unadjusted OR(95% CI)	Adjusted^a OR(95% CI)	Unadjusted OR(95% CI)	Adjusted^a OR(95% CI)
Gender male	0.65 (0.34–1.20)	0.71 (0.36–1.36)	0.50 (0.22–1.03)	0.59 (0.25–1.28)
Age (years)	1.01 (0.98–1.05)	1.00 (0.97–1.04)	1.02 (0.98–1.06)	1.01 (0.97–1.06)
Length of RACF stay (years)	1.10 (1.01–1.20)	1.09 (0.99–1.20)	1.13 (1.03–1.24)	1.10 (1.00–1.22)
CCI	0.98 (0.82–1.16)	1.03 (0.86–1.23)	0.91 (0.75–1.11)	0.97 (0.78–1.18)
DSRS	0.99 (0.98–1.01)	0.97 (0.94–0.99)	0.99 (0.98–1.01)	0.95 (0.92–0.98)
FRAIL-NH	1.06 (0.99–1.14)	1.13 (1.03–1.24)	1.13 (1.04–1.22)	1.26 (1.13–1.41)
Katz-ADL	0.90 (0.77–1.03)	–	0.81 (0.67–0.96)	–

Note: ^aMultivariate model did not include Katz-ADL due to collinearity with FRAIL-NH score.

Abbreviations: ADL, activities of daily living; CCI, Charlson Comorbidity Index; CI, confidence interval; DSRS, Dementia Severity Rating Scale; MRCI, Medication Regimen Complexity Index; OR, odds ratio; RACF, residential aged care facility.