Skip to main content
Log in

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

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  5. Iadecola C, Anrather J. Stroke research at a crossroad: asking the brain for directions. Nat Neurosci. 2011;14(11):1363–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  12. Frank M, Conzelmann M, Engelter S. Prediction of discharge destination after neurological rehabilitation in stroke patients. Eur Neurol. 2010;63(4):227–33.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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. https://doi.org/10.1111/ggi.13187.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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

Funding

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

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eiji Kose.

Ethics declarations

Conflicts of interest

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kose, E., Hirai, T., Seki, T. et al. The association of increased drugs use with activities of daily living and discharge outcome among elderly stroke patients. Int J Clin Pharm 40, 599–607 (2018). https://doi.org/10.1007/s11096-018-0610-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-018-0610-3

Keywords

Navigation