International Journal of Clinical Pharmacy

, Volume 40, Issue 3, pp 599–607 | Cite as

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

  • Eiji KoseEmail author
  • Toshiyuki Hirai
  • Toshiichi Seki
  • Hiroyuki Hayashi
Research Article


Background Few systematic studies have evaluated the association between drugs and functional recovery for geriatric patients after strokes in the convalescent stage. Objective To assess the association of increased drugs during hospitalization with activities of daily living and outcome among geriatric stroke patients. Setting This study was conducted at the convalescent rehabilitation ward in the Hitachinaka General Hospital in Japan. Methods This retrospective cohort study included consecutive patients aged ≥ 65 years who had experienced stroke between 2010 and 2016. The participants were classified into two groups according to their discharge destination: home discharge group and non-home discharge group. Multiple linear regression analysis and multiple logistic regression analysis were used to examine the association of increased drugs with FIM gain and home discharge, respectively. Main outcome measures: The main outcome measures were Functional Independence Measure (FIM) gain and home discharge. Results In total, 417 participants (165 males and 252 females; mean age, 78.8 years) were assessed and classified into home discharge (n = 226) and non-home discharge (n = 191) groups. The median FIM score was 77 (interquartile range 57–96). Multiple linear regression analysis revealed that increased use of drugs during hospitalization negatively correlated with FIM gain. Multiple logistic regression analysis showed that increased use of drugs was independently associated with a low possibility of home discharge. Conclusion The increased use of drugs during hospitalization was negatively associated with both functional recovery and possibility of home discharge among geriatric stroke patients in a convalescent rehabilitation ward.


Discharge Functional Independence Measure Japan Medication Rehabilitation ward Stroke 



The authors thank the manager of Hitachinaka General Hospital who agreed for this study to take place.


This study was not sponsored or funded by any industry, government, or institution.

Conflicts of interest

The authors declare no conflict of interest.


  1. 1.
    Miyai I, Sonoda S, Nagai S, Takayama Y, Inoue Y, Kakehi A, et al. Results of new policies for inpatient rehabilitation coverage in Japan. Neurorehabil Neural Repair. 2015;25(6):540–7.CrossRefGoogle Scholar
  2. 2.
    Tanaka H, Ueda Y, Hayashi M, Date C, Baba T, Yamashita H, et al. Risk factors for cerebral hemorrhage and cerebral infarction in a Japanese rural community. Stroke. 1982;13(1):62–73.CrossRefPubMedGoogle Scholar
  3. 3.
    Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham Study. Stroke. 1991;22(3):312–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Iso H, Jacobs DR Jr, Wentworth D, Neaton JD, Cohen JD. Serum cholesterol levels and sixyear mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N Engl J Med. 1989;320(14):904–10.CrossRefPubMedGoogle Scholar
  5. 5.
    Iadecola C, Anrather J. Stroke research at a crossroad: asking the brain for directions. Nat Neurosci. 2011;14(11):1363–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Sonoda S, Saitoh E, Nagai S, Kawakita M, Kanada Y. Full-time integrated treatment program, a new system for stroke rehabilitation in Japan: comparison with conventional rehabilitation. Am J Phys Med Rehabil. 2004;83(2):88–93.CrossRefPubMedGoogle Scholar
  7. 7.
    Hama S, Yamashita H, Kato T, Shigenobu M, Watanabe A, Sawa M, et al. Insistence on recovery’ as a positive prognostic factor in Japanese stroke patients. Psychiatry Clin Neurosci. 2008;62(4):386–95.CrossRefPubMedGoogle Scholar
  8. 8.
    Dumbreck S, Flynn A, Nairn M, Wilson M, Treweek S, Mercer SW, et al. Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines. BMJ. 2015;350:h949.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Campbell SE, Seymour DG. Primrose WR; ACMEPLUS Project. A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing. 2004;33(2):110–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Espino DV, Bazaldua OV, Palmer RF, Mouton CP, Parchman ML, Miles TP, et al. Suboptimal medication use and mortality in an older adult community-based cohort: results from the Hispanic EPESE Study. J Gerontol A Biol Sci Med Sci. 2006;61(2):170–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Inouye M, Kishi K, Ikeda Y, Takada M, Katoh J, Iwahashi M, et al. Prediction of functional outcome after stroke rehabilitation. Am J Phys Med Rehabil. 2000;79(6):513–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Frank M, Conzelmann M, Engelter S. Prediction of discharge destination after neurological rehabilitation in stroke patients. Eur Neurol. 2010;63(4):227–33.CrossRefPubMedGoogle Scholar
  13. 13.
    Massucci M, Perdon L, Agosti M, Celani MG, Righetti E, Recupero E, et al. Prognostic factors of activity limitation and discharge destination after stroke rehabilitation. Am J Phys Med Rehabil. 2006;85(12):963–70.CrossRefPubMedGoogle Scholar
  14. 14.
    Jehkonen M, Ahonen JP, Dastidar P, Koivisto AM, Laippala P, Vilkki J, et al. Predictors of discharge to home during the first year after right hemisphere stroke. Acta Neurol Scand. 2001;104(3):136–41.CrossRefPubMedGoogle Scholar
  15. 15.
    Shen Q, Cordato D, Chan DK, Hung WT, Karr M. Identifying the determinants of 1-year post- stroke outcomes in elderly patients. Acta Neurol Scand. 2006;113(2):114–20.CrossRefPubMedGoogle Scholar
  16. 16.
    Thommessen B, Bautz-Holter E, Laake K. Predictors of outcome of rehabilitation of elderly stroke patients in a geriatric ward. Clin Rehabil. 1999;13(2):123–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Wee JY, Hopman WM. Stroke impairment predictors of discharge function, length of stay, and discharge destination in stroke rehabilitation. Am J Phys Med Rehabil. 2005;84(8):604–12.CrossRefPubMedGoogle Scholar
  18. 18.
    McKenna K, Tooth L, Strong J, Ottenbacher K, Connell J, Cleary M. Predicting discharge outcomes for stroke patients in Australia. Am J Phys Med Rehabil. 2002;81(1):47–56.CrossRefPubMedGoogle Scholar
  19. 19.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med. 1999;130(6):461–70.CrossRefPubMedGoogle Scholar
  20. 20.
    Henley S, Pettit S, Todd-Pokropek A, Tupper A. Who goes home? Predictive factors in stroke recovery. J Neurol Neurosurg Psychiatry. 1985;48(1):1–6.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Granger Carl V. Hamilton, Bvron B, Keith, Robert A, Zielezny, Maria, Sherwin, Frances S: Advances in functional assessment in medical rehabilitation. Top Geriatr Rehabil. 1986;1:59–74.CrossRefGoogle Scholar
  22. 22.
    Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil. 1996;77(12):1226–32.CrossRefPubMedGoogle Scholar
  23. 23.
    Mutai H, Furukawa T, Araki K, Misawa K, Hanihara T. Factors associated with functional recovery and home discharge in stroke patients admitted to a convalescent rehabilitation ward. Geriatr Gerontol Int. 2012;12(2):215–22.CrossRefPubMedGoogle Scholar
  24. 24.
    Field TS, Gurwitz JH, Avorn J, McCormick D, Jain S, Eckler M, et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med. 2001;161(13):1629–34.CrossRefPubMedGoogle Scholar
  25. 25.
    Kojima T, Akishita M, Kameyama Y, Yamaguchi K, Yamamoto H, Eto M, et al. High risk of adverse drug reactions in elderly patients taking six or more drugs: analysis of inpatient database. Geriatr Gerontol Int. 2012;12(4):761–2.CrossRefPubMedGoogle Scholar
  26. 26.
    Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;54(6):508–13.CrossRefGoogle Scholar
  27. 27.
    Barker MJ, Greenwood KM, Jackson M, Crowe SF. Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs. 2004;18(1):37–48.CrossRefPubMedGoogle Scholar
  28. 28.
    Eitan N, Levin Y, Ben-Artzi E, Levy A, Neumann M. Effects of antipsychotic drugs on memory functions of schizophrenic patients. Acta Psychiatr Scand. 1992;85(1):74–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Heruti RJ, Lusky A, Barell V, Ohry A, Adunsky A. Cognitive status at admission: does it affect the rehabilitation outcome of elderly patients with hip fracture? Arch Phys Med Rehabil. 1999;80(4):432–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Langhorne P, Taylor G, Murray G, Dennis M, Anderson C, Bautz-Holter E, et al. Early supported discharge services for stroke patients: a meta-analysis of individual patients’ data. Lancet. 2005;365(9458):501–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Dent L, Agosti M, Franceschini M. Outcome predictors of rehabilitation for first stroke in the elderly. Eur J Phys Rehabil Med. 2008;44(1):3–11.Google Scholar
  32. 32.
    Miyamoto H, Hagihara A, Nobutomo K. Predicting the discharge destination of rehabilitation patients using a signal detection approach. J Rehabil Med. 2008;40(4):261–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Fick DM, Semla TP, Beizer J, Brandt N, Dombrowski R, DuBeau CE, et al. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015;63(11):2227–46.CrossRefGoogle Scholar
  34. 34.
    Kose E, Hirai T, Seki T, Hayashi H. Role of potentially inappropriate medication use in rehabilitation outcomes for geriatric patients after strokes. Geriatr Gerontol Int. 2017. Scholar
  35. 35.
    O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Roth EJ, Heinemann AW, Lovell LL, Harvey RL, McGuire JR, Diaz S. Impairment and disability: their relation during stroke rehabilitation. Arch Phys Med Rehabil. 1998;79(3):329–35.CrossRefPubMedGoogle Scholar
  37. 37.
    Maeshima S, Osawa A, Hayashi T, Tanahashi N. Factors Associated with prognosis of eating and swallowing disability after stroke: a study from a community-based stroke care system. J Stroke Cerebrovasc Dis. 2013;22(7):926–30.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pharmacotherapy, School of PharmacyNihon UniversityChibaJapan
  2. 2.Department of PharmacyHitachinaka General HospitalIbarakiJapan

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