Antipsychotic Prescribing and Drug-related Readmissions in Multimorbid Older Inpatients: a Post-hoc Analysis of the OPERAM Population

Overview

Journal Int J Clin Pharm

Publisher Springer

Specialties Pharmacology
Pharmacy

Date 2024 Feb 17

PMID 38367103

Authors

A Bienfait

J Lagreula

M R Blum

N Rodondi

B T G M Sallevelt

W Knol

D OMahony

A Spinewine

B Boland

O Dalleur

Affiliations

Soon will be listed here.

Abstract

Background: Limited data are available on characteristics associated with antipsychotic use in multimorbid older adults.

Aim: Primary: to identify patient characteristics associated with antipsychotic prescribing in a multimorbid population of older inpatients with polypharmacy. Secondary: (1) to observe if antipsychotics use during an index hospitalisation was associated with a drug related admission (DRA) within one year, and (2) to describe these cases of antipsychotic-related readmissions.

Method: This was a secondary analysis of the OPERAM randomized controlled trial. Multivariate analysis assessed the association between characteristics and comorbidities with antipsychotic use. An expert team assessed DRA occurring during the one-year follow-up.

Results: Antipsychotics were prescribed to 5.5% (n = 110) patients upon admission while 7.7% (n = 154) inpatients received antipsychotics at any time (i.e. upon admission, during hospitalisation, and/or at discharge). The most frequently prescribed antipsychotics were quetiapine (n = 152), haloperidol (n = 48) and risperidone (n = 22). Antipsychotic prescribing was associated with dementia (OR = 3.7 95%CI[2.2;6.2]), psychosis (OR = 26.2 [7.4;92.8]), delirium (OR = 6.4 [3.8;10.8]), mood disorders (OR = 2.6 [1.6;4.1]), ≥ 15 drugs a day (OR = 1.7 [1.1;2.6]), functional dependency (Activities of Daily Living score < 50/100) (OR = 3.9 [2.5;6.1]) and < 2 units of alcohol per week (OR = 2.2 [1.4;3.6]). DRA occurred in 458 patients (22.8%) within one year. Antipsychotic prescribing at any time was not associated with DRA (OR = 1.0 [0.3;3.9]) however contributed to 8 DRAs, including 3 falls.

Conclusion: In this European multimorbid polymedicated older inpatients, antipsychotics were infrequently prescribed, most often at low dosage. Besides neuro-psychiatric symptoms, risk factors for inhospital antipsychotic prescribing were lower functional status and polymedication.

References

McKean A, Monasterio E . Indications of atypical antipsychotics in the elderly. Expert Rev Clin Pharmacol. 2014; 8(1):5-7. DOI: 10.1586/17512433.2015.974557. View

Oscanoa T, Lizaraso F, Carvajal A . Hospital admissions due to adverse drug reactions in the elderly. A meta-analysis. Eur J Clin Pharmacol. 2017; 73(6):759-770. DOI: 10.1007/s00228-017-2225-3. View

Somers A, Robays H, Vander Stichele R, Van Maele G, Bogaert M, Petrovic M . Contribution of drug related problems to hospital admission in the elderly. J Nutr Health Aging. 2010; 14(6):477-82. DOI: 10.1007/s12603-009-0237-0. View

Chan M, Nicklason F, Vial J . Adverse drug events as a cause of hospital admission in the elderly. Intern Med J. 2001; 31(4):199-205. DOI: 10.1046/j.1445-5994.2001.00044.x. View

Rogers S, Wilson D, Wan S, Griffin M, Rai G, Farrell J . Medication-related admissions in older people: a cross-sectional, observational study. Drugs Aging. 2009; 26(11):951-61. DOI: 10.2165/11316750-000000000-00000. View

OMahony D, Cherubini A, Renom Guiteras A, Denkinger M, Beuscart J, Onder G . STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023; 14(4):625-632. PMC: 10447584. DOI: 10.1007/s41999-023-00777-y. View

Park S, Kim A, Ah Y, Lee M, Lee Y, Chae J . Prevalence and predictors of medication-related emergency department visit in older adults: A multicenter study linking national claim database and hospital medical records. Front Pharmacol. 2022; 13:1009485. PMC: 9614024. DOI: 10.3389/fphar.2022.1009485. View

Ballard C, Hanney M, Theodoulou M, Douglas S, McShane R, Kossakowski K . The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol. 2009; 8(2):151-7. DOI: 10.1016/S1474-4422(08)70295-3. View

Doherty A, Shahid F, Moriarty F, Boland F, Clyne B, Dreischulte T . Prescribing cascades in community-dwelling adults: A systematic review. Pharmacol Res Perspect. 2022; 10(5):e01008. PMC: 9485823. DOI: 10.1002/prp2.1008. View

10.

Renom-Guiteras A, Thurmann P, Miralles R, Klaassen-Mielke R, Thiem U, Stephan A . Potentially inappropriate medication among people with dementia in eight European countries. Age Ageing. 2017; 47(1):68-74. DOI: 10.1093/ageing/afx147. View

11.

Bargagli A, Cascini S, Agabiti N, Kirchmayer U, Marino C, Davoli M . Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy. Clin Interv Aging. 2019; 14:2071-2083. PMC: 6877449. DOI: 10.2147/CIA.S218641. View

12.

Stock K, Hogan D, Lapane K, Amuah J, Tyas S, Bronskill S . Antipsychotic Use and Hospitalization Among Older Assisted Living Residents: Does Risk Vary by Frailty Status?. Am J Geriatr Psychiatry. 2017; 25(7):779-790. DOI: 10.1016/j.jagp.2017.02.013. View

13.

Rikala M, Korhonen M, Sulkava R, Hartikainen S . Psychotropic drug use in community-dwelling elderly people-characteristics of persistent and incident users. Eur J Clin Pharmacol. 2011; 67(7):731-9. DOI: 10.1007/s00228-011-0996-5. View

14.

Sonnerstam E, Gustafsson M, Lovheim H, Sjolander M . Potentially Inappropriate Medications Pre- and Post-Diagnosis of Major Neurocognitive Disorders Among Older People in Sweden: A Register-Based, 6-Year Longitudinal Study. Drugs Aging. 2022; 39(7):573-585. PMC: 9279237. DOI: 10.1007/s40266-022-00947-w. View

15.

Oh S, Byeon S, Chung S . Characteristics of adverse reactions among antipsychotic drugs using the Korean Adverse Event Reporting System database from 2010 to 2019. J Psychopharmacol. 2022; 36(9):1041-1050. DOI: 10.1177/02698811221104055. View

16.

Adam L, Moutzouri E, Baumgartner C, Loewe A, Feller M, MRabet-Bensalah K . Rationale and design of OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM): a cluster randomised controlled trial. BMJ Open. 2019; 9(6):e026769. PMC: 6561415. DOI: 10.1136/bmjopen-2018-026769. View

17.

Blum M, Sallevelt B, Spinewine A, OMahony D, Moutzouri E, Feller M . Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial. BMJ. 2021; 374:n1585. PMC: 8276068. DOI: 10.1136/bmj.n1585. View

18.

MAHONEY F, BARTHEL D . FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965; 14:61-5. View

19.

Thevelin S, Spinewine A, Beuscart J, Boland B, Marien S, Vaillant F . Development of a standardized chart review method to identify drug-related hospital admissions in older people. Br J Clin Pharmacol. 2018; 84(11):2600-2614. PMC: 6177723. DOI: 10.1111/bcp.13716. View

20.

Rhee Y, Csernansky J, Emanuel L, Chang C, Shega J . Psychotropic medication burden and factors associated with antipsychotic use: an analysis of a population-based sample of community-dwelling older persons with dementia. J Am Geriatr Soc. 2011; 59(11):2100-7. PMC: 3230879. DOI: 10.1111/j.1532-5415.2011.03660.x. View