Deans' stroke musings: Polypharmacy and Potentially Inappropriate Medications in Stroke Rehabilitation: Prevalence and Impact

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, December 8, 2021

Polypharmacy and Potentially Inappropriate Medications in Stroke Rehabilitation: Prevalence and Impact

Something for your doctor to have protocols on.

Polypharmacy and Potentially Inappropriate Medications in Stroke Rehabilitation: Prevalence and Impact

Matsumoto A,

Yoshimura Y,

Nagano F,

Bise T,

Kido Y,

Shimazu S,

Shiraishi A

Preprint from Research Square, 30 Nov 2021
DOI: 10.21203/rs.3.rs-1012014/v1 PPR: PPR426739

Preprint

This article is a preprint. It may not have been peer reviewed.

Abstract

Background:

Evidence is scarce regarding the polypharmacy and potentially inappropriate medications (PIMs) in rehabilitation medicine.

Aim

To investigate the prevalence and impact on outcomes of polypharmacy and PIMs in stroke rehabilitation.

Methods

A retrospective cohort study was conducted with 849 older inpatients after 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 impact 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 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 = -0.072, P = 0.017), FIM-cognitive score (β = -0.077, P = 0.011), energy intake (β = -0.147, P = 0.004), and home discharge (OR: 0.499; 95% CI: 0.280, 0.802; P = 0.015). PIMs were negatively associated with energy intake (β = -0.066, P = 0.042) and home discharge (OR: 0.452; 95% CI: 0.215, 0.756; P = 0.005).

Conclusions

Polypharmacy and PIMs are commonly found among older patients undergoing stroke rehabilitation. Moreover, polypharmacy and PIMs are negatively associated with outcomes.