TY - JOUR
T1 - Medications Associated With Geriatric Syndromes (MAGS) and Hospitalization Risk in Home Health Care Patients
AU - Wang, Jinjiao
AU - Shen, Jenny Y.
AU - Yu, Fang
AU - Conwell, Yeates
AU - Nathan, Kobi
AU - Shah, Avantika S.
AU - Simmons, Sandra F.
AU - Li, Yue
AU - Ramsdale, Erika
AU - Caprio, Thomas V.
N1 - Publisher Copyright:
© 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2022/10
Y1 - 2022/10
N2 - Objectives: Polypharmacy is common in home health care (HHC). This study examined the prevalence of medications associated with geriatric syndromes (MAGS), its predictors, and association with subsequent hospitalization in HHC. Design: Analysis of HHC electronic medical records, the Outcome and Assessment Information Set (OASIS), and Medicare HHC claims. Setting and Participants: A total of 6882 adults ≥65 years old receiving HHC in 2019 from a large, not-for-profit home health agency serving multiple counties in New York State. Measures: MAGS use was identified from active medications reconciled during HHC visits (HHC electronic medical records). MAGS use was operationalized as count and in quartiles. Hospitalization during the HHC episode was operationalized as a time-to-event variable (ie, number of days from HHC admission to hospitalization). We used regression analyses to identify predictors of MAGS use, and survival analyses to examine the association between MAGS and hospitalization. Results: Nearly all (98%) of the HHC patients used at least 1 MAGS and 41% of all active medications used by the sample were MAGS. More MAGS use was found in HHC patients who were community-referred, taking more medications, and having more diagnoses, depressive symptoms, and functional limitations. Adjusted for covariates, higher MAGS quartiles were not independently associated with the risk of hospitalization, but higher MAGS quartiles combined with multimorbidity (ie, having ≥10 diagnoses) were associated with a 2.3-fold increase in hospitalization risk (hazard ratio 2.24; 95% confidence interval: 1.61–3.13; P < .001), relative to the lowest quartile of MAGS use and having <10 diagnoses. Conclusions and Implications: More than 40% of medications taken by HHC patients are MAGS. Multimorbidity and MAGS use collectively increased the risk of hospitalization by up to 2.3 times. HHC clinicians should carefully review patients' medications and use information about MAGS to facilitate discussion about deprescribing with patients and their prescribers.
AB - Objectives: Polypharmacy is common in home health care (HHC). This study examined the prevalence of medications associated with geriatric syndromes (MAGS), its predictors, and association with subsequent hospitalization in HHC. Design: Analysis of HHC electronic medical records, the Outcome and Assessment Information Set (OASIS), and Medicare HHC claims. Setting and Participants: A total of 6882 adults ≥65 years old receiving HHC in 2019 from a large, not-for-profit home health agency serving multiple counties in New York State. Measures: MAGS use was identified from active medications reconciled during HHC visits (HHC electronic medical records). MAGS use was operationalized as count and in quartiles. Hospitalization during the HHC episode was operationalized as a time-to-event variable (ie, number of days from HHC admission to hospitalization). We used regression analyses to identify predictors of MAGS use, and survival analyses to examine the association between MAGS and hospitalization. Results: Nearly all (98%) of the HHC patients used at least 1 MAGS and 41% of all active medications used by the sample were MAGS. More MAGS use was found in HHC patients who were community-referred, taking more medications, and having more diagnoses, depressive symptoms, and functional limitations. Adjusted for covariates, higher MAGS quartiles were not independently associated with the risk of hospitalization, but higher MAGS quartiles combined with multimorbidity (ie, having ≥10 diagnoses) were associated with a 2.3-fold increase in hospitalization risk (hazard ratio 2.24; 95% confidence interval: 1.61–3.13; P < .001), relative to the lowest quartile of MAGS use and having <10 diagnoses. Conclusions and Implications: More than 40% of medications taken by HHC patients are MAGS. Multimorbidity and MAGS use collectively increased the risk of hospitalization by up to 2.3 times. HHC clinicians should carefully review patients' medications and use information about MAGS to facilitate discussion about deprescribing with patients and their prescribers.
KW - Home health care
KW - deprescribing
KW - medications associated with geriatric syndromes
KW - polypharmacy
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U2 - 10.1016/j.jamda.2022.03.012
DO - 10.1016/j.jamda.2022.03.012
M3 - Article
C2 - 35490716
AN - SCOPUS:85129936093
SN - 1525-8610
VL - 23
SP - 1627-1633.e3
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 10
ER -