Pharmacoepidemiol Drug Saf. 2022 Dec 30. doi: 10.1002/pds.5590. Online ahead of print.
ABSTRACT
PURPOSE: Investigate the association between anticholinergic (AC) and sedative (SED) drug burden before hospitalization and post-discharge institutionalization (PDI) in community-dwelling older patients acutely admitted to hospital.
METHODS: A cross-sectional study using data from the Norwegian Patient Registry and the Norwegian Prescription Database. We studied acutely hospitalized community-dwelling patients ≥70 years during 2013 (N=86,509). Patients acutely admitted to geriatric wards underwent subgroup analyses (n=1,715). We calculated drug burden by the Drug Burden Index (DBI), use of AC/SED drugs, and the number of AC/SED drugs. Piecewise linearity of DBI vs PDI and a knot point (DBI=2.45) was identified. Statistical analyses included an adjusted multivariable logistic regression model.
RESULTS: In the total population, 45.4% were exposed to at least one AC/SED drug, compared to 52.5% in the geriatric subgroup. AC/SED drugs were significantly associated with PDI. The DBI with Odds Ratios (ORs) of 1.11 (95% CI 1.07-1.15) for DBI<2.45 and 1.08 (95% CI 1.04-1.13) for DBI≥2.45. The number of AC/SED drugs with OR of 1.07 (95% CI 1.05-1.09). The AC component of DBI with OR 1.23 and the number of AC drugs with OR 1.13. In the subgroup, ORs were closer to 1 for AC drugs.
CONCLUSIONS: The use of AC/SED drugs was highly prevalent in older patients before acute hospital admissions, and significantly associated with PDI. The number, or just using AC/SED drugs, gave similar associations with PDI compared to applying the DBI. Using AC drugs showed higher sensitivity, indicating that to reduce the risk of PDI, a clinical approach could be to reduce the number of AC drugs.
PMID:36585814 | DOI:10.1002/pds.5590
