Advertisement
Original Study| Volume 22, ISSUE 1, P96-100.e5, January 2021

Initiation of Psycholeptic Medication During Hospitalization With Recommendation for Discontinuation After Discharge

Published:September 15, 2020DOI:https://doi.org/10.1016/j.jamda.2020.08.004

      Abstract

      Objectives

      Psycholeptic drugs have been used in the older population for years, especially to control delirium and neuropsychiatric symptoms (NPS) of dementia. However, data from the literature confirm that the prolonged use of psycholeptics may be responsible for adverse reactions in older patients. The aim of this study was (1) to identify how many patients receive the first prescription of a psycholeptic drug during the hospital stay; (2) to evaluate the main sociodemographic and clinical characteristics of these patients; and (3) to verify if the prescribed psycholeptic drugs are continued after 3 months from the hospital discharge.

      Design

      Our retrospective study was based on data from the REPOSI (REgistro POliterapie SIMI) registry, a cohort of older patients hospitalized in internal medicine and geriatric wards throughout Italy from 2010 to 2018.

      Setting and Participants

      Patients aged 65 years or older who were not on home therapy with psycholeptic drugs were considered in the analyses.

      Methods

      We did both univariate and multivariate analyses in order to find the variables associated independently to an increased risk for first psycholeptic prescription at hospital discharge.

      Results

      At hospital discharge, 193 patients (5.8%) out of a total sample of 3322 patients were prescribed at least 1 psycholeptic drug. Cognitive impairment was the main risk factor for the introduction of psycholeptic drugs at discharge. Among them, 89.1% were still on therapy with a psycholeptic drug after 3 months from the hospital discharge.

      Conclusions and Implications

      Cognitive impairment represents the main risk factor for psycholeptic initiation in hospitalized older patients. The vast majority of these treatments are chronically continued after the discharge. Therefore, special attention is needed in prescribing psycholeptics at discharge, because their prolonged use may lead to cognitive decline. Moreover, their continued use should be questioned by physicians providing post-acute care, and deprescribing should be considered.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cho S.
        • Lau S.W.
        • Tandon V.
        • et al.
        Geriatric drug evaluation: Where are we now and where should we be in the future?.
        Arch Intern Med. 2011; 171: 937-940
        • Rowe J.W.
        • Andres R.
        • Tobin J.D.
        • et al.
        The effect of age on creatinine clearance in men: A cross-sectional and longitudinal study.
        J Gerontol. 1976; 31: 155-163
        • Tan J.L.
        • Eastment J.G.
        • Poudel A.
        • Hubbard R.E.
        Age related changes in hepatic function an update on implications for drug therapy.
        Drugs Aging. 2015; 32: 999-1008
        • Wright R.M.
        • Roumani Y.F.
        • Boudreau R.
        • et al.
        Effect of central nervous system medication use on decline in cognition in community-dwelling older adults: Findings from the Health, Aging and Body Composition Study.
        J Am Geriatr Soc. 2009; 57: 243-250
        • Zuidema S.U.
        • Johansson A.
        • Selbaek G.
        • et al.
        A consensus guideline for antipsychotic drug use for dementia in care homes. Bridging the gap between scientific evidence and clinical practice.
        Int Psychogeriatr. 2015; 27: 1849-1859
        • Thom R.P.
        • Mock C.K.
        • Teslyar P.
        Delirium in hospitalized patients: Risks and benefits of antipsychotics.
        Cleve Clin J Med. 2017; 84: 616-622
        • Johnson K.G.
        • Fashoyin A.
        • Madden-Fuentes R.
        • et al.
        Discharge plans for geriatric inpatients with delirium: A plan to stop antipsychotics?.
        J Am Geriatr Soc. 2017; 65: 2278-2281
        • Livingston G.
        • Walker A.E.
        • Katona C.L.
        • Cooper C.
        Antipsychotics and cognitive decline in Alzheimer’s disease: The LASER-Alzheimer’s disease longitudinal study.
        J Neurol Neurosurg Psychiatry. 2007; 78: 25-29
        • Wolf A.
        • Leucht S.
        • Pajonk F.G.
        Do antipsychotics lead to cognitive impairment in dementia? A meta-analysis of randomised placebo-controlled trials.
        Eur Arch Psychiatry Clin Neurosci. 2017; 267: 187-198
        • Levin E.D.
        • Rezvani A.H.
        Nicotinic interactions with antipsychotic drugs models of schizophrenia and impacts on cognitive function.
        Biochem Pharmacol. 2007; 74: 1182-1191
        • Van Leeuwen E.
        • Petrovic M.
        • van Driel M.L.
        • et al.
        Discontinuation of long-term antipsychotic drug use for behavioral and psychological symptoms in older adults aged 65 years and older with dementia.
        J Am Med Dir Assoc. 2018; 19: 1009-1014
        • Ma H.
        • Huang Y.
        • Cong Z.
        • et al.
        The efficacy and safety of atypical antipsychotics fort the treatment of dementia: A meta-analysis of randomized placebo-controlled trials.
        J Alzheimers Dis. 2014; 42: 915-937
        • Reynish E.L.
        • Hapca S.M.
        • De Souza N.
        • et al.
        Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: Prospective cohort study of 10014 admissions.
        BMC Med. 2017; 15: 140
        • Bellelli G.
        • Morandi A.
        • Di Santo S.G.
        • et al.
        "Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool.
        BMC Med. 2016; 14: 106
        • Ryan D.J.
        • O'Regan N.A.
        • Caoimh R.Ó.
        • et al.
        Delirium in an adult acute hospital population: Predictors, prevalence and detection.
        BMJ Open. 2013; 3e001772
        • Wu Y.C.
        • Tseng P.T.
        • Tu Y.K.
        • et al.
        Association of delirium response and safety of pharmacological interventions for the management and prevention of delirium: A network meta-analysis.
        JAMA Psychiatry. 2019; 76: 526-535
        • Shen Y.Z.
        • Peng K.
        • Zhang J.
        • et al.
        Effects of haloperidol on delirium in adult patients: A systematic review and meta-analysis.
        Med Princ Pract. 2018; 27: 250-259
        • Neufeld K.J.
        • Yue J.
        • Robinson T.N.
        • et al.
        Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: A systematic review and meta-analysis.
        J Am Geriatr Soc. 2016; 64: 705-714
        • Agar M.R.
        • Lawlor P.G.
        • Quinn S.
        • et al.
        Oral risperidone, haloperidol or placebo for delirium symptoms in palliative care: A multi-site, double-blind, parallel arm, dose-titrated randomized controlled trial.
        JAMA Intern Med. 2017; 177: 34-42
        • Nobili A.
        • Licata G.
        • Salerno F.
        • et al.
        Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study.
        Eur J Clin Pharmacol. 2011; 67: 507-519
        • WHO Collaborating Centre for Drugs Statistics Methodology
        Guidelines for ATC classification and DDD assignment.
        5th ed. WHO, Oslo2002
        • Linn B.S.
        • Linn M.W.
        • Gurel L.
        Cumulative illness rating scale.
        J Am Geriatr Soc. 1968; 16: 622-626
        • Shah S.
        • Vanclay F.
        • Cooper B.
        Improving the sensitivity of the Barthel index for stroke rehabilitation.
        J Clin Epidemiol. 1989; 42: 703-709
        • Katzman R.
        • Brown T.
        • Fuld P.
        • et al.
        Validation of a short Orientation-Memory-Concentration Test of cognitive impairment.
        Am J Psychiatry. 1983; 140: 734-739
        • World Health Organization
        International Classification of Diseases, Injuries, and Causes of Death. Ninth revision (ICD-9).
        WHO, Geneva1987
        • Zou G.
        A modified Poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004; 159: 702-706
        • Mannucci P.M.
        • Nobili A.
        • Pasina L.
        REPOSI collaborators (REPOSI is the acronym of REgistro POliterapie SIMI, Società Italiana di Medicina interna). Polypharmacy in older people: Lessons from 10 years of experience with the REPOSI register.
        Intern Emerg Med. 2018; 13: 1191-1200
        • Scales D.C.
        • Fischer H.D.
        • Li P.
        • et al.
        Unintentional continuation of medications intended for acute illness after hospital discharge: A population-based cohort study.
        J Gen Intern Med. 2016; 31: 196-202
        • Grimmsmann T.
        • Harden M.
        • Fiß T.
        • Himmel W.
        The influence of hospitalisation on the initiation, continuation and discontinuation of benzodiazepines and Z-drugs—an observational study.
        Swiss Med Wkly. 2018; 148: w14590
        • Rodrigues C.R.
        • Harrington A.R.
        • Murdock N.
        • et al.
        Effect of pharmacy-supported transition-of-care interventions on 30-day readmissions: A systematic review and meta-analysis.
        Ann Pharmacother. 2017; 51: 866-889
        • Chiesa D.
        • Marengoni A.
        • Nobili A.
        • et al.
        Antipsychotic prescription and mortality in hospitalized older persons.
        Psychogeriatrics. 2017; 17: 397-405
        • Foucher N.
        • Lahille B.
        • Bernard N.P.
        • et al.
        Influence of hospitalisation on the elderly people polypharmacy.
        Rev Med Interne. 2009; 30 ([in French]): 20-24
        • Marcantonio E.R.
        Delirium in hospitalized older adults.
        N Engl J Med. 2017; 377: 1456-1466
        • Gross A.L.
        • Jones R.N.
        • Habtemariam D.A.
        • et al.
        The long-term effect of delirium on the cognitive trajectory in persons with dementia.
        Arch Intern Med. 2012; 172: 1324-1331
        • Uzun S.
        • Kozumplik O.
        • Jakovljević M.
        • Sedić B.
        Side effects of treatment with benzodiazepines.
        Psychiatr Danub. 2010; 22: 90-93
        • Sanders R.D.
        • Maze M.
        Contribution of sedative-hypnotic agents to delirium via modulation of the sleep pathway.
        Can J Anaesth. 2011; 58: 149-156
        • Pinot J.
        • Herr M.
        • Robine J.M.
        • et al.
        Does the prescription of anxiolytic and hypnotic drugs increase mortality in older adults?.
        J Am Geriatr Soc. 2015; 63: 1263-1265
        • Charlson F.
        • Degenhardt L.
        • McLaren J.
        • et al.
        A systematic review of research examining benzodiazepine-related mortality.
        Pharmacoepidemiol Drug Saf. 2009; 18: 93-103
        • Weich S.
        • Pearce H.L.
        • Croft P.
        • et al.
        Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: Retrospective cohort study.
        BMJ. 2014; 348: g1996
        • Kripke D.F.
        • Langer R.D.
        • Kline L.E.
        Hypnotics’ association with mortality or cancer: A matched cohort study.
        BMJ Open. 2012; 2: e000850
        • Shenkin S.D.
        • Russ T.C.
        • Ryan T.M.
        • MacLullich A.M.
        Screening for dementia and other causes of cognitive impairment in general hospital in-patients.
        Age Ageing. 2014; 43: 166-168
        • Rossi P.D.
        • Bilotta C.
        • Consonni D.
        • et al.
        Predictors of clinical events occurring during hospital stay among elderly patients admitted to medical wards in Italy.
        Eur J Intern Med. 2016; 32: 38-42
        • Rothman K.J.
        • Gallacher J.E.
        • Hatch E.E.
        Why representativeness should be avoided.
        Int J Epidemiol. 2013; 42: 1012-1014
        • Richiardi L.
        • Pizzi C.
        • Pearce N.
        Commentary: Representativeness is usually not necessary and often should be avoided.
        Int J Epidemiol. 2013; 42: 1018-1022