The association of increased drugs use with activities of daily living and discharge outcome among elderly stroke patients

Nonsteroidal anti-inflammatory drug use is associated with improved activities of daily living and rehabilitation in older adult patients following a fracture: a retrospective cohort study

BACKGROUND

Insufficient rehabilitation due to postfracture pain can result in muscle atrophy and joint contractures, which may affect the improvement of activities of daily living (ADL). This study investigated the impact of using nonsteroidal anti-inflammatory drugs (NSAIDs) on the improvement of ADL in older adult patients with fractures admitted to a convalescent rehabilitation unit.

METHODS

Of 489 older adult patients with fractures from January 2017 to June 2019, 261 fulfilled the requirements for this retrospective cohort analysis. Patients who had convalescent rehabilitation following a fracture were categorized into two groups: those who used NSAIDs and those who did not. The functional independence measure-total gain (FIM-total) score, which was used for evaluating ADL, was the main outcome measure. We ascertained the independent relationship between NSAIDs use and rehabilitation outcomes using a multiple linear regression analysis. Covariates selected to correct bias included age, sex (male), BMI, hypertension, dementia, cardiovascular disease, cerebrovascular disease, upper limb paralysis, femoral fracture, lumbar compression fracture, thoracic compression fracture, pelvic fracture, patellar fracture, FIM-total at admission, number of drugs, acetaminophen use.

RESULTS

The mean participant age was 82.3 ± 7.4 years, 69 (26.4%) of them were men, and 94 (36%) used NSAIDs. Multiple linear regression analysis revealed that NSAIDs use was independently associated with FIM-total gain during hospitalization (β=2.311, P=0.013).

CONCLUSIONS

These findings suggest that the appropriate use of NSAIDs may play a beneficial role in maximizing rehabilitation outcomes. However, careful monitoring for potential adverse effects is essential, particularly in older adults.

Impacts of increases and decreases of drugs on rehabilitation outcomes of subacute stroke patients

OBJECTIVE

To examine changes in drugs for subacute stroke patients and elucidate the impact of medications on rehabilitation outcomes.

MATERIALS AND METHODS

A total of 295 subacute stroke patients who were admitted to the convalescent rehabilitation ward between June 2018 and May 2019 were included. Polypharmacy was defined as five or more drugs at admission. The primary outcome was the Functional Independence Measure Total score (FIM-T) at discharge. Multiple regression analysis was performed to examine the relationships between the FIM-T at discharge and drug changes or other factors. This study was conducted in two stages. The first analysis included all stroke patients, and the second analysis included only stroke patients with polypharmacy.

RESULTS

On multiple regression analysis, the number of drugs at admission (β=-0.628) was associated with FIM-T at discharge of all stroke patients. Furthermore, the number of additional drugs during hospitalization (β=-1.964) was associated with FIM-T at discharge in the 176 stroke patients with polypharmacy.

CONCLUSION

This study suggested that the number of drugs at admission and the addition of drugs during hospitalization might have a negative impact on the rehabilitation outcomes of subacute stroke patients.

Association between deprescribing from polypharmacy and functional recovery and home discharge among older patients with sarcopenia after stroke

OBJECTIVE

Evidence regarding the association between deprescribing from polypharmacy and outcomes in the convalescent rehabilitation setting is rare. The aim of this study was to assess the association between deprescribing from polypharmacy and functional recovery and home discharge in older patients with sarcopenia after stroke.

METHODS

This retrospective cohort study was conducted at a convalescent rehabilitation hospital from January 2015 to December 2021. Among newly admitted patients in the convalescent rehabilitation ward who had experienced a stroke, patients aged ≥65 y with sarcopenia at admission and who were using at least five medications were included. Sarcopenia was diagnosed according to hand-grip strength and skeletal muscle mass index following the criteria of the Asian Working Group for Sarcopenia 2019. The primary outcome measures were functional independence-measured motor activity (FIM-motor) at discharge and home discharge. Multiple regression analysis was used to determine whether deprescribing from polypharmacy at admission was independently associated with rehabilitation outcomes.

RESULTS

Among the 264 patients with polypharmacy, 153 patients (mean age, 81.1 y; 46.4% males) were diagnosed with sarcopenia and included in the analysis. Of them, 56 (36.6%) were deprescribed from polypharmacy. Deprescribing from polypharmacy was independently associated with FIM-motor at discharge (β, 0.137; P = 0.017) and home discharge (odds ratio, 1.393; P = 0.002).

CONCLUSIONS

Because no effective pharmacotherapy for sarcopenia has been established, the novel findings of this study may be useful in the pharmacotherapy for older patients with sarcopenia after stroke. Deprescribing from polypharmacy on admission was positively associated with functional status at discharge and home discharge in older patients with sarcopenia after stroke.

Effect of Comorbidity Burden and Polypharmacy on Poor Functional Outcome in Acute Ischemic Stroke

PURPOSE

Comorbidities and polypharmacy are risk factors for worse outcome in stroke. However, comorbidities and polypharmacy are mostly studied separately with various approaches to assess them. We aimed to analyze the impact of comorbidity burden and polypharmacy on functional outcome in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT).

METHODS

Acute ischemic stroke patients with large vessel occlusion (LVO) treated with MT from a prospective observational study were analyzed. Relevant comorbidity burden was defined as a Charlson Comorbidity Index (CCI) score ≥ 2, polypharmacy as the intake of ≥ 5 medications at time of stroke onset. Favorable outcome was a score of 0-2 on the modified Rankin scale at 90 days after stroke. The effect of comorbidity burden and polypharmacy on favorable outcome was studied via multivariable regression analysis.

RESULTS

Of 903 patients enrolled, 703 AIS patients (mean age 73.4 years, 54.9% female) with anterior circulation LVO were included. A CCI ≥ 2 was present in 226 (32.1%) patients, polypharmacy in 315 (44.8%) patients. Favorable outcome was less frequently achieved in patients with a CCI ≥ 2 (47, 20.8% vs. 172, 36.1%, p < 0.001), and in patients with polypharmacy (69, 21.9% vs. 150, 38.7%, p < 0.001). In multivariable regression analysis including clinical covariates, a CCI ≥ 2 was associated with lower odds of favorable outcome (odds ratio, OR 0.52, 95% confidence interval, 95% CI 0.33-0.82, p = 0.005), while polypharmacy was not (OR 0.81, 95% CI 0.52-1.27, p = 0.362).

CONCLUSION

Relevant comorbidity burden and polypharmacy are common in AIS patients with LVO, with comorbidity burden being a risk factor for poor outcome.

Cognitive function is associated with home discharge in subacute stroke patients: a retrospective cohort study

Aim

To investigate the cognitive function and its relation to the home discharge of patients following subacute stroke.

Methods

This retrospective cohort study included 1,229 convalescent patients experiencing their first subacute stroke. We determined discharge destination and demographic and clinical information. We recorded the following measurement scores: Mini-Mental State Examination (MMSE) score, Stroke Impairment Assessment Set score, grip strength, and Functional Independence Measure (FIM). We performed a multivariable logistic regression analysis with the forced-entry method to identify factors related to home discharge.

Results

Of the 1,229 participants (mean age: 68.7 ± 13.5 years), 501 (40.8%), 735 (59.8%), and 1,011 (82.3%) were female, had cerebral infarction, and were home discharged, respectively. Multivariable logistic regression analysis revealed that age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91 – 0.96; P < 0.001), duration from stroke onset to admission (OR, 0.98; 95% CI, 0.96 – 0.99; P = 0.003), living situation (OR, 4.40; 95% CI, 2.69 – 7.20; P < 0.001), MMSE score at admission (OR, 1.05; 95% CI, 1.00 – 1.09; P = 0.035), FIM motor score at admission (OR, 1.04; 95% CI, 1.01 – 1.06; P = 0.001), and FIM cognitive score at admission (OR, 1.08; 95% CI, 1.04 – 1.13; P < 0.001) were significantly associated with home discharge.

Conclusions

MMSE at admission is significantly associated with home discharge in patients with subacute stroke.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-022-02745-8.

Polypharmacy and potentially inappropriate medications in stroke rehabilitation: prevalence and association with outcomes

Background Evidence is scarce regarding polypharmacy and potentially inappropriate medications (PIMs) in rehabilitation medicine. Aim To investigate the prevalence of polypharmacy and PIMs and their association with outcomes in stroke rehabilitation. Method A retrospective cohort study was conducted with 849 older inpatients post-stroke. Polypharmacy was defined as six or more medications, and PIMs were defined based on Beers criteria 2019. Study outcomes included functional independence measure (FIM)-motor, FIM-cognitive, energy intake, dysphagia, length of hospital stay, and the rate of home discharge. To consider the effect of pharmacotherapy during rehabilitation, multivariate analyses were used to determine whether the presence of polypharmacy or PIMs at discharge was associated with outcomes. Results After enrollment, 361 patients (mean age 78.3 ± 7.7 years; 49.3% male) were analyzed. Polypharmacy was observed in 43.8% and 62.9% of patients, and any PIMs were observed in 64.8% and 65.4% of patients at admission and discharge, respectively. The most frequently prescribed PIMs included antipsychotics, benzodiazepines, and proton pump inhibitors. Polypharmacy was negatively associated with FIM-motor score (β = - 0.062, P = 0.049), FIM-cognitive score (β = - 0.076, P = 0.014), energy intake (β = - 0.143, P = 0.005), and home discharge (OR: 0.458; 95% CI: 0.248, 0.847; P = 0.013). PIMs were negatively associated with home discharge (OR: 0.375; 95% CI: 0.195, 0.718; P = 0.003). Conclusion Polypharmacy and PIMs are commonly found among older patients undergoing stroke rehabilitation. Moreover, polypharmacy was negatively associated with activities of daily living (ADL) but not with PIMs and ADLs, and both were associated with home discharge.

What activities of daily living at discharge affect the discharge destination of patients in an acute-care hospital in Japan: A retrospective factor analysis

It is important to clarify the influence of activities of daily living (ADL) at discharge on the discharge destination of hospitalised patients. The Functional Independence Measure (FIM) is a widely used ADL assessment scale. In this retrospective study, we aimed to identify what ADL based on FIM at discharge affect the discharge destination of hospitalised patients in an acute-care hospital, in addition to how nutritional status and the number of drugs used, as well as types of disease, affect discharge-to-home. We surveyed age, sex, disease type, length of hospital stay, discharge destination, FIM score at discharge, serum albumin level, and the number of continued drugs in hospitalised patients who underwent rehabilitation in Gifu Municipal Hospital (Gifu, Japan) between January 2014 and December 2014. Multiple logistic regression analysis was performed with discharge to home as a dependent variable and age, sex, disease, FIM score and polypharmacy as independent variables. Multiple logistic regression analysis indicated that a significantly high percentage of discharged-to-home patients were associated with 'self-care' (≥33 points; OR: 2.03), 'sphincter control' (≥14 points; OR: 1.49), 'transfers' (≥13 points; OR: 1.94), and 'locomotion' (≥7 points; OR: 3.55), among others. High FIM sub-scale scores at discharge for self-care, sphincter control, transfers, and locomotion were clarified as factors associated with discharge-to-home. These findings of the association of ADL based on FIM and discharge destination would be useful in deciding discharge destinations for patients in an acute-phase hospital.

Pharmacist medication instructions are associated with continued medication self-management in older adults: a retrospective observational study

Background

Various factors are related to self-management of medication. However, few reports comprehensively examine the factors related to patients, medication levels, and other factors related to the recuperative environment, such as family support. The aim of this study was to investigate factors affecting the continuation of medication self-management among hospitalized older adults receiving convalescent rehabilitation.

Methods

We conducted a retrospective observational study with 274 consecutive patients newly admitted to the convalescent rehabilitation wards at a single hospital in Japan between January 2017 and May 2018. Participants who were assessed for their ability to take their medication using the Japanese Regimen Adherence Capacity Tests, were deemed to be self-manageable, and were able to successfully continue to self-manage their medication from admission to discharge were categorized as the “continuation group,” and those who were not able to continue were categorized as the “non-continuation group.” We analyzed the groups’ demographic data, laboratory data, and Functional Independence Measure. The primary outcome was the continuation of medication self-management from admission to discharge.

Results

After enrollment, 134 patients (median age 82 years; 62.7% women) were included in the final analysis. Some 60.4% of eligible patients were able to maintain medication self-management during their hospitalization. The multiple logistic regression analysis for the continuation of medication self-management during hospitalization after adjusting for confounding factors revealed that pharmacist medication instructions were independently and positively correlated with successful continuation of medication self-management (odds ratio: 1.378; 95% confidence interval 1.085–1.831; p = 0.0076).

Conclusion

Successful continuation of medication self-management is associated with pharmacist medication instructions among hospitalized older adults undergoing rehabilitation.

Trail registration

The Ethics Committee’s registration number is “TGE01216–066”.

Polypharmacy, functional outcome and treatment effect of intravenous alteplase for acute ischaemic stroke

BACKGROUND AND PURPOSE

Polypharmacy is an important challenge in clinical practice. Our aim was to determine the effect of polypharmacy on functional outcome and treatment effect of alteplase in acute ischaemic stroke.

METHODS

This was a post hoc analysis of the randomized, placebo-controlled WAKE-UP trial of magnetic resonance imaging guided intravenous alteplase in unknown onset stroke. Polypharmacy was defined as an intake of five or more medications at baseline. Comorbidities were assessed by the Charlson Comorbidity Index (CCI). The primary efficacy variable was favourable outcome defined by a score of 0-1 on the modified Rankin Scale at 90 days. Logistic regression analysis was used to test for an association of polypharmacy with functional outcome, and for interaction of polypharmacy and the effect of thrombolysis.

RESULTS

Polypharmacy was present in 133/503 (26%) patients. Patients with polypharmacy were older (mean age 70 vs. 64 years; p < 0.0001) and had a higher score on the National Institutes of Health Stroke Scale at baseline (median 7 vs. 5; p = 0.0007). A comorbidity load defined by a CCI score ≥ 2 was more frequent in patients with polypharmacy (48% vs. 8%; p < 0.001). Polypharmacy was associated with lower odds of favourable outcome (adjusted odds ratio 0.50, 95% confidence interval 0.30-0.85; p = 0.0099), whilst the CCI score was not. Treatment with alteplase was associated with higher odds of favourable outcome in both groups, with no heterogeneity of treatment effect (test for interaction of treatment and polypharmacy, p = 0.29).

CONCLUSION

In stroke patients, polypharmacy is associated with worse functional outcome after intravenous thrombolysis independent of comorbidities. However, polypharmacy does not interact with the beneficial effect of alteplase.

Impact of Number of Drugs on Rehabilitation Outcomes in Patients after Traumatic Brain Injury: A Retrospective Cohort Study

OBJECTIVE

To investigate the impact of the number of drugs on rehabilitation outcomes for patients with acute traumatic brain injury.

DESIGN

Retrospective cohort study.

SETTING

Hospital-based database created by the Japan Medical Data Center.

PARTICIPANTS

Patients with acute traumatic brain injury admitted between April 2014 and November 2017.

METHODS

Analysis of relationships among 1-5 and ≥ 6 drugs as well as clinical outcomes in 2603 patients.

MAIN OUTCOME MEASUREMENTS

The primary outcome was defined as the Barthel index efficiency, and the secondary outcome was Barthel index gain and length of hospital stay.

RESULTS

Median Barthel index score on admission was 40. Barthel index efficiency and Barthel index gain were significantly higher in the group that had taken 1-5 drugs than in the group that had taken ≥6 drugs on admission (median: 1.19 vs 0.50, 20.0 vs 10.0). Also, the group that had taken 1-5 drugs had a significantly shorter length of hospital stay than in the group that had taken ≥6 drugs on admission (median 11.0 vs 14.0). Moreover, multiple linear regression analysis showed that having taken ≥6 drugs on admission was independently associated with Barthel index efficiency, Barthel index gain, and length of stay.

CONCLUSIONS

Taking≥6 drugs for acute traumatic brain injury was associated with lower Barthel index efficiency, lower Barthel index gain, and longer length of stay than taking 1-5 drugs.

The association between polypharmacy and the efficiency of the functional independence measure in an acute-stage hospital: a retrospective cohort study

BACKGROUND

The Functional Independence Measure (FIM) evaluates the activities of daily living (ADL), and FIM efficiency represents daily improvement in FIM. Polypharmacy affects both ADL and FIM; however, few studies have evaluated its relationship with FIM efficiency.

AIM

This retrospective study investigated the effect of polypharmacy on FIM efficiency in patients undergoing rehabilitation at our acute care hospital in 2014.

METHODS

We collected data on the patients' age, sex, diagnosis, length of hospital stay, type and duration of rehabilitation, indications for rehabilitation, FIM score before and after rehabilitation, and number of pharmaceuticals being used. Polypharmacy was defined as the administration of five or more pharmaceuticals. Using propensity score matching, we compared the FIM efficiency between the polypharmacy and non-polypharmacy groups (sub-scales and totals).

RESULTS

A total of 2455 patients were included. The analytical population included 2168 patients. The analytical population used for propensity score matching included 727 patients in each group (total: 1454 patients). The following FIM sub-scale items were found to be associated with significantly low FIM efficiency in the polypharmacy group: self-care (polypharmacy group FIM efficiency: 0.43 points/day, non-polypharmacy group FIM efficiency: 0.54 points/day) and sphincter control (0.11 points/day and 0.18 points/day, respectively). No significant differences in the FIM efficiency were observed either for any other sub-scales or for totals.

DISCUSSION

In the polypharmacy group, self-care and sphincter control, in particular, were associated with inhibited improvement in ADL and FIM.

CONCLUSIONS

Reducing polypharmacy among acute-phase patients would allow an earlier return to their normal daily lives.

Impact of Number of Drug Types on Clinical Outcome in Patients with Acute Hip Fracture

OBJECTIVES

This study aims to investigate the impact of the number of drug types on clinical outcomes for patients with acute hip fracture.

DESIGNS

This is a retrospective cross-sectional study.

SETTING

A hospital-based database constructed by the Japan Medical Data Center.

PARTICIPANTS

Consecutive patients exhibiting acute hip fractures on admission between April 2014 and November 2017 were included.

MEASUREMENTS

Relationships among the numbers of varying drug types of ≥6 and ≤5 as well as clinical outcomes were analyzed in 11,073 patients aged ≥65 years. The primary outcome was defined as the Barthel Index efficiency, with the secondary outcome being the length of hospital stay.

RESULTS

Median Barthel Index scores at admission and discharge were 5 (interquartile range: 5-20) and 50 (interquartile range: 20-85). The Barthel Index efficiency was significantly higher in the group having received 5 or fewer drug variations taken (1.45 ± 1.77) than in the group receiving 6 or more drug types taken (0.94 ± 1.18) during hospital stays (p < 0.001). The length of hospital stay was significantly shorter in the group receiving 5 or fewer drug types taken (29.9 ± 23.8) than in the group having 6 or more drug types taken (44.3 ± 30.3) during hospital stays (p < 0.001), with the latter number being independently associated with the Barthel Index efficiency and length of hospital stay.

CONCLUSIONS

Number of drug types of 6 or more were associated with lower Barthel Index efficiency and longer lengths of hospital stays.