Functional Status among Polymedicated Geriatric Inpatients at Discharge: A Population-Based Hospital Register Analysis
, Boris Wernli 3, Armin von Gunten 4, MarÃa del Rio Carral 5, Maria Manuela Martins 6 and Henk Verloo 2,4Round 1
Reviewer 1 Report
In this manuscript the authors give a perspective of the "burden" of polypharmacotherapy on functional status in a geriatric population at discarge from a Cantonal Hospital in Suisse. Were analysed more than 50000 records and the results are really interesting. I have only few considerations to recommend to the authors:
1) Suisse Health System is different from other european countries: it is possible that it could make some differences both in admission and accordingly at discarge from hospital? So far how much this type of Health System could be a determinant in prescribing medicaments once the patient is discarged and returns to be assisted from her/his general practitioner?
2) One fundamental information is the reason for which patients were admitted to Hospital and authors mentioned that patients presented three or more comorbidities. Would it be possible to have percentages of main morbidities?
3) Table 3 needs to invert polymedicated columns (polymedicated first and than non-polymedicated)
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
I appreciate your efforts to correlate functional status with polymedication among geriatric inpatients. The introduction to the manuscript clearly introduces the importance of the aging of the population with increasing hospitalizations among older adults, often leading to functional decline and inability to return home at the time of discharge. You also present the concept of polypharmacy, including demographic information regarding individuals most likely to meet criteria for polypharmacy. I would note that polypharmacy is only one aspect considered when reviewing the appropriateness of pharmacologic therapy in older adults. Many geriatricians have moved away from the concept of polypharmacy (defined by a certain number of medications) to instead focus on appropriate and inappropriate prescribing. I question if this would much more closely correlate with your proposed outcome of functional status at the time of hospital discharge in older adults.
The Materials and Methods section was well-written and clearly described the study design, source of the population, and data analysis. I have no concerns regarding this portion of the manuscript.
The Results section was quite detailed and included a large amount of information regarding the study population and physical and cognitive status of individuals with polymedication versus those without polymedication. My concern is that a simple analysis of the relationship to polypharmacy to functional and cognitive status fails to draw any clear conclusions. I suspect you would have found much more compelling conclusions, with more consistency, if they had instead compared function to appropriate pharmacologic therapy using tools such as the BEERS criteria or STOPP/START and/or a comparison of the anticholinergic burden. This is suggested as an area for future study. In addition, it is possible that individuals with increased cognitive impairment and increased impairment in certain areas of physical function (i.e. 13 identified variables) were less likely to be polymedicated as their goals of care were more focused on comfort or they were nearer to the end of life. However, this is not clear from the information provided.
I appreciate the detailed level of information provided in the manuscript on the important issue of medication use and function in older adults. However, based on the information provided, it is unclear to me how clinicians can use this data to change their clinical practice give mixed function in various categories among older adults who are polymedicated versus those who are not. The importance of careful pharmacologic management in older adults, focused on ensuring the use of appropriate medications, is already quite clear and it is unclear to me that this manuscript meaningfully adds to the already available literature on this topic.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
I appreciate the modifications which you have made to the manuscript. They have strengthened your study description and conclusions. Polypharmacy/appropriate medication usage in older adults is key to improving care, and ensuring care aligns with matters most. This manuscript is an addition to the current literature.
