Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.
San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
J Gerontol A Biol Sci Med Sci. 2024 Nov 1;79(11). doi: 10.1093/gerona/glae207.
Hospitalizations are frequently disruptive for persons with dementia (PWD) in part due to the use of potentially problematic medications for complications such as delirium, pain, and insomnia. We sought to determine the impact of hospitalizations on problematic medication prescribing in the months following hospitalization.
We included community-dwelling PWD in the Health and Retirement Study aged ≥66 with a hospitalization from 2008 to 2018. We characterized problematic medications as medications that negatively affect cognition (strongly anticholinergics/sedative-hypnotics), medications from the 2019 Beers criteria, and medications from STOPP-V2. To capture durable changes, we compared problematic medications 4 weeks prehospitalization (baseline) to 4 months posthospitalization period. We used a generalized linear mixed model with Poisson distribution adjusting for age, sex, comorbidity count, prehospital chronic medications, and timepoint.
Among 1 475 PWD, 504 had a qualifying hospitalization (median age 84 (IQR = 79-90), 66% female, 17% Black). There was a small increase in problematic medications from the baseline to posthospitalization timepoint that did not reach statistical significance (adjusted mean 1.28 vs 1.40, difference 0.12 (95% CI -0.03, 0.26), p = .12). Results were consistent across medication domains and certain subgroups. In one prespecified subgroup, individuals on <5 prehospital chronic medications showed a greater increase in posthospital problematic medications compared with those on ≥5 medications (p = .04 for interaction, mean increase from baseline to posthospitalization of 0.25 for those with <5 medications (95% CI 0.05, 0.44) vs. 0.06 (95% CI -0.12, 0.25) for those with ≥5 medications).
Hospitalizations had a small, nonstatistically significant effect on longer-term problematic medication use among PWD.
住院治疗常常会给痴呆症患者（PWD）带来困扰，部分原因是为了治疗谵妄、疼痛和失眠等并发症而使用了可能存在问题的药物。我们旨在确定住院治疗对住院后数月内问题药物处方的影响。
我们纳入了健康与退休研究中的社区居住的 PWD，年龄≥66 岁，2008 年至 2018 年期间住院治疗。我们将对认知产生负面影响的药物（强抗胆碱能药物/镇静催眠药）、2019 年 Beers 标准中的药物和 STOPP-V2 中的药物定义为问题药物。为了捕捉持久变化，我们将住院前 4 周（基线）与住院后 4 个月期间的问题药物进行比较。我们使用具有泊松分布的广义线性混合模型进行调整，调整因素包括年龄、性别、合并症数量、住院前慢性药物和时间点。
在 1475 名 PWD 中，有 504 名患者符合资格要求（中位年龄 84（IQR=79-90）岁，66%为女性，17%为黑人）。从基线到住院后时间点，问题药物略有增加，但未达到统计学意义（调整后的平均值 1.28 与 1.40，差异 0.12（95%CI-0.03，0.26），p=0.12）。结果在各个药物领域和某些亚组中是一致的。在一个预先指定的亚组中，与服用≥5 种住院前慢性药物的患者相比，服用<5 种药物的患者在住院后问题药物的增加更为明显（p=0.04 用于交互作用，与服用≥5 种药物的患者相比，服用<5 种药物的患者从基线到住院后药物的平均增加量为 0.25（95%CI0.05，0.44），而服用≥5 种药物的患者为 0.06（95%CI-0.12，0.25））。
住院治疗对 PWD 长期使用问题药物的影响较小，且无统计学意义。
