Is anticholinergic and sedative drug burden associated with postdischarge institutionalization in community‐dwelling older patients acutely admitted to hospital? A Norwegian registry‐based study. Issue 6 (10th January 2023)

• Record Type: Journal Article
• Authors: Havnes, Kjerstin; Svendsen, Kristian; Johansen, Jeanette Schultz; Granas, Anne Gerd; Garcia, Beate Hennie; Halvorsen, Kjell H.
• Is Part Of: Pharmacoepidemiology and drug safety. Volume 32:Issue 6(2023)
• Page Start: 607
• Page End: 616
• Publication Date: 2023-01-10
• Subjects: anticholinergics -- drug burden index -- hospitalization -- institutionalization -- National Health Registries -- older patients -- sedatives; Pharmacoepidemiology -- Periodicals; Chemotherapy -- Periodicals; Epidemiology -- Periodicals; 615.705
• DOI: 10.1002/pds.5590
• Languages: English
• ISSNs: 1053-8569

Abstract

Abstract: Purpose: Investigate the association between anticholinergic (AC) and sedative (SED) drug burden before hospitalization and postdischarge 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 = 1715). 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 versus 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.