Association between Acute Geriatric Syndromes and Medication-Related Hospital Admissions

Abstract

Background Elderly patients are at a four-fold higher risk of adverse drug events (ADEs) and drug related hospitalization. Hospitalization of an elderly patient is often preceded by geriatric syndromes, like falls or delirium. Objectives The primary aim of this study is to investigate whether geriatric syndromes were associated with ADEs in acutely admitted elderly patients. Methods Consecutive medical patients, aged 65 years or more, and were acutely admitted, were enrolled. An initial multidisciplinary evaluation was completed and baseline characteristics were collected. A fall before admission was retrieved from medical charts. Delirium was determined by the Confusion Assessment Method. Results A total of 641 patients were included. Over 25% had an ADE present at admission, 26% presented with delirium and 12% with a fall. Delirium was associated with the use of antidepressants, antipsychotics, and antiepileptics. In all ADEs (N=167), ADE was associated with a fall, with NSAIDs or diuretics, but not with pre-existing functioning, delirium or older age. For ADEs involving psychoactive medication (N=35), an association was found between delirium, fall, opioids and antipsychotics in bivariate analyses. A fall just before hospitalization (OR 3.69 [95% CI 1.41–9.67]), antipsychotics (OR 3.70 [95% CI 1.19–11.60]) and opioids (OR 14.57 [95% CI 2.02–105.30]) remained independently associated with an ADE involving psychoactive medication. Conclusion This prospective study demonstrated that in a cohort of elderly hospital patients a fall before admission and prevalent delirium are associated with several pharmacological groups and/or with ADE-related hospital admission.

Risk factors for adverse drug reactions in older inpatients of geriatric wards at admission: Multicenter study

“…In contrast, another study that surveyed long-term care residents reported that the most common manifestations were delirium, oversedation and falls. 23 Because the present study was carried out in geriatric wards of acute care hospitals, more patients with acute conditions would have been identified. A case-control study that surveyed ADR in older patients presenting to the emergency department found similar findings (a mixture of acute conditions and geriatric syndromes), consistent with the present findings.…”

The Value of Unstructured Electronic Health Record Data in Geriatric Syndrome Case Identification

“…Geriatric syndromes are correlated with high morbidity and mortality and high healthcare use, such as hospitalizations, emergency department (ED) visits, and nursing home admissions . “Geriatric syndromes” is a term used to capture complex and multifactorial clinical conditions in older adults that do not fit into discrete disease categories .…”

“…G eriatric syndromes are correlated with high morbidity and mortality 1 and high healthcare use, such as hospitalizations, emergency department (ED) visits, and nursing home admissions. [2][3][4][5][6] "Geriatric syndromes" is a term used to capture complex and multifactorial clinical conditions in older adults that do not fit into discrete disease categories. 7 Geriatric syndromes usually lack well-defined etiological or pathogenetic factors 8,9 but share multiple synergistic risk factors such as older age and functional, cognitive, and sensory impairments.…”

Geriatric Syndromes in Hospitalized Older Adults Discharged to Skilled Nursing Facilities

“…Moreover, failure to document geriatric syndromes at hospital discharge could delay or prevent the development of care plans to manage these syndromes during the SNF stay and at SNF discharge. Recent data document that SNF discharge planning is often inadequate and that a high percentage of people are readmitted to the hospital after SNF discharge …”

“…Recent data document that SNF discharge planning is often inadequate and that a high percentage of people are readmitted to the hospital after SNF discharge. [7][8][9][10]13 Although it is important to assess geriatric syndromes for all older hospitalized adults, these syndromes may have greater clinical significance in people discharged to SNFs for several reasons. First, a greater proportion of Medicare beneficiaries are discharged to a SNF than to any other post-acute care setting.…”