Clinical Scorecard: Polypharmacy and Functional Independence in Older Adults Receiving Cerebrovascular Rehabilitation: An Observational Study of Japanese Real-World Data

At a Glance

Key Highlights

• This retrospective observational study used Japanese real-world inpatient and pharmacy claims data.

• Polypharmacy was defined as use of six or more medications.

• FIM gain was not significantly associated with polypharmacy status.

• All three groups with polypharmacy at admission and/or discharge had lower FIM efficiency and longer hospital stays than the persistent non-polypharmacy group.

Guideline-Based Recommendations

Diagnosis

• Assess medication counts at admission and discharge; the study defined polypharmacy as use of six or more medications.

• Classify patients as having persistent non-polypharmacy, resolved polypharmacy, incident polypharmacy, or persistent polypharmacy based on medication status at both time points.

Management

• Review medication use during rehabilitation, including changes between admission and discharge.

• Consider the potential risks associated with sedative, hypnotic, and anticholinergic medications when reviewing prescriptions; the study did not test specific deprescribing interventions.

Monitoring & Follow-up

• Track functional outcomes using admission and discharge FIM scores, distinguishing FIM gain from FIM efficiency.

• Consider length of stay when interpreting FIM efficiency, which was calculated as FIM gain divided by length of stay.

• Review medication counts at discharge as well as admission to identify resolved or incident polypharmacy.

Risks

• The article notes associations between some sedative, hypnotic, and anticholinergic drugs and falls, cognitive impairment, delirium, or functional decline.

• Polypharmacy groups had lower FIM efficiency and longer hospital stays than the persistent non-polypharmacy group, although the observational study cannot establish that polypharmacy caused these outcomes.

Patient & Prescribing Data

Patients aged 65 years or older admitted for the first time to a convalescent rehabilitation ward for cerebrovascular rehabilitation; patients who died during hospitalization, stayed 14 days or less, received anticancer agents, or lacked admission or discharge FIM data were excluded.

Medication groups were persistent non-polypharmacy, resolved polypharmacy, incident polypharmacy, and persistent polypharmacy. As-needed medications and topical agents were excluded from counts, except daily topical treatments used for systemic effects; combination drugs counted as one medication.

Clinical Best Practices

• The study classified polypharmacy status using medication counts at admission and discharge.

• FIM gain and FIM efficiency were distinct outcomes: FIM gain was the admission-to-discharge score difference, and FIM efficiency divided FIM gain by length of stay.

• The study found no significant association between polypharmacy status and FIM gain; its retrospective observational design does not establish causation.

Related Resources & Content

Ogawa Y, Horii T, Sakoh M, Mihara K. Polypharmacy and activities of daily living in older patients undergoing cerebrovascular rehabilitation: an observational study using Japanese real-world data. Drugs Real World Outcomes. Published online October 12, 2026. doi:10.1007/s40801-026-00589-z