Medications associated with dizziness or hypotension and adverse outcomes: an electronic health record study in older adults with dementia.

BACKGROUND

Comorbidities and polypharmacy are common in people with dementia, leading to a higher risk of adverse outcomes. While the impact of anticholinergic properties has been extensively investigated, less is known about other cross-category properties of medications.

OBJECTIVE

To investigate whether medications with dizziness or hypotension as a side effect are associated with adverse outcomes in older adults with dementia.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

From a South London catchment, 15 210 patients diagnosed with dementia between 2008 and 2017.

METHODS

Medications with dizziness and/or hypotension listed as a side effect were compiled and quantified in the cohort. Multivariable Cox regression models were run to determine the risk of mortality, all-cause emergency hospitalisation and hospitalisation due to falls. Generalised estimating equations were applied to investigate cognitive decline. The final model adjusted for 19 potential confounders, including physical and mental health measures.

RESULTS

Of the patients, 82.2% were receiving at least one dizziness-associated medication and 71.2% at least one hypotension-associated medication. For each additional medication associated with dizziness or hypotension, there was a 4% increased risk of all-cause emergency hospitalisation. No associations were found with hospitalised falls specifically or with mortality or cognitive decline.

CONCLUSION

Medications that potentially cause dizziness or hypotension were associated with an increased risk of hospitalisation, although not specifically hospitalisation caused by falls. More systematic attention should be paid to coprescribing around the time of dementia diagnosis and the potential for rationalising this to minimise adverse drug events.