Association between comprehensive geriatric assessment and polypharmacy at discharge in patients with ischaemic stroke: A nationwide, retrospective, cohort study

Hosoi, Tomohiro; Yamana, Hayato; Tamiya, Hiroyuki; Matsui, Hiroki; Fushimi, Kiyohide; Akishita, Masahiro; Yasunaga, Hideo; Ogawa, Sumito

doi:10.1016/j.eclinm.2022.101528

Cited by 8 publications

(4 citation statements)

References 31 publications

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“…Covariates included age (75–79, 80–84, 85–89, 90–94, ≥95 years), sex, body mass index (<18.5, 18.5–25.0, 25.0–30.0, ≥30.0 kg/m 2 ), smoking status (current or former smoker), Charlson comorbidity index (0–2, ≥3), 16 the number of prescribed medications reflecting polypharmacy (0–4: non‐polypharmacy, 5–9: polypharmacy, ≥10: hyper‐polypharmacy), 17 comorbidities related to falls or bone fractures, medications related to falls or bone fractures, and any rehabilitation. The variables included in the analyses were based on previous studies of falls and fractures 15,18–27 .…”

Section: Methodsmentioning

confidence: 99%

“…15,[18][19][20][21][22][23][24][25][26][27] Table S2 provides additional details on these variables. In line with a previous study, 17 we extracted data for 88 types of frequently prescribed medications, or those with a potential for causing adverse drug events in older persons. Of these, we excluded short-acting non-benzodiazepine hypnotics and nitric acid medicines because these are not covered by Japanese public health insurance, resulting in a total of 86 categories (Table S3).…”

Section: Outcomes and Covariatesmentioning

confidence: 99%

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Association between subjective physical function and occurrence of new fractures in older adults: A retrospective cohort study

Sato,

Sasabuchi,

Aso

et al. 2024

Geriatrics Gerontology Int

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BackgroundThe Late‐Stage Elderly Questionnaire has been incorporated into health assessments for older adults in Japan, encompassing three self‐administered questions on subjective physical function: subjective gait speed decline, recent fall history, and exercise habits. Nevertheless, its efficacy in predicting new fracture occurrences remains uncertain.MethodsThis retrospective cohort study utilized Japan's DeSC database, a large commercially available claims database. Participants were older adults aged ≥75 years and provided complete responses to the Late‐Stage Elderly Questionnaire at health check‐ups. We performed two Cox regression analyses for new fractures based on the responses to the three questions (Model 1) and on age, sex, and responses to the three questions (Model 2). The predictive abilities of the 1‐year occurrence of new fractures were compared between the two models.ResultsOf 11 683 eligible older adults, 927 (7.93%) experienced new fractures. Model 1 revealed significant associations between new fractures and subjective gait speed decline (hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.40–1.89), recent fall history (HR, 2.03; 95% CI, 1.77–2.33), and absence of exercise habits (HR, 1.29; 95% CI, 1.13–1.47). Model 2 demonstrated superior predictive ability (area under the curve, 0.677; 95% CI, 0.659–0.695) compared with Model 1 (area under the curve, 0.633; 95% CI, 0.614–0.652), with a net reclassification improvement of 0.383 (95% CI, 0.317–0.449).ConclusionThree subjective physical well‐being factors were significantly associated with new fracture development in older adults. These results suggest that the three‐question assessment may be a valuable screening tool for identifying new fractures. Geriatr Gerontol Int 2024; ••: ••–••.

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Section: Methodsmentioning

confidence: 99%

Section: Outcomes and Covariatesmentioning

confidence: 99%

Association between subjective physical function and occurrence of new fractures in older adults: A retrospective cohort study

Sato,

Sasabuchi,

Aso

et al. 2024

Geriatrics Gerontology Int

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“…We used the Diagnostic Procedure Combination database, a nationwide administrative claims and discharge abstract database in Japan, 10 with >1000 participating hospitals. The database contains data on age, sex, main diagnosis, comorbidities at admission, in‐hospital complications (coded by the International Classification of Diseases, 10th Revision [ICD‐10]), length of stay, medical procedures, medications and discharge status.…”

Section: Methodsmentioning

confidence: 99%

Association between the type of hypnotic drug and in‐hospital fractures in older patients with neurocognitive disorders: A case–control study using a nationwide database

Matsumoto

Tamiya

Yamana

et al. 2023

Geriatrics Gerontology Int

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Hypnotics might increase the risk of falls and fractures in older patients with neurocognitive disorders. Orexin receptor antagonists have recently been approved, but the relationship between the new drugs and fractures remains unclarified. This study aimed to evaluate the association between the type of hypnotic and in-hospital fractures in older patients with neurocognitive disorders using a nationwide inpatient database.Methods: Using the Japanese Diagnosis Procedure Combination database, we collected information on inpatients aged ≥65 years with neurocognitive disorders between April 2014 and March 2021. We examined trends in the prescription patterns of benzodiazepine drugs, Z-drugs, orexin receptor antagonists and melatonin receptor agonists. We also carried out a 1:4 matched case-control analysis of in-hospital fractures. The odds ratio of each hypnotic drug was estimated using a generalized estimating equation with adjustment for walking ability, comorbidities, osteoporosis, dialysis, selective serotonin reuptake inhibitor use and antidementia drug use. Results:The prescription of benzodiazepine hypnotics decreased and that of orexin receptor antagonists increased. This case-control analysis included 6832 patients with fractures and 23 463 controls. Ultrashort-acting benzodiazepines, short-acting benzodiazepines and Z-drugs were associated with an increased risk of bone fracture (odds ratio [95% confidence interval] 1.

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“…Cognitive decline has also been reported to be closely associated with medication adherence [14][15][16][17] and may be an essential indicator for clinicians to decide whether or not to continue medication therapy. Regarding medication adjustment, which includes deprescribing as a process to improve medication adherence in the older patients, the suitability of the Comprehensive Geriatric Assessment (CGA) [18,19], a method that represents problems in areas such as cognitive function, activities of daily living (ADLs), psychology, nutrition, medications, and social status of patients, has been reported [20][21][22][23][24]. The Dementia Assessment Sheet for Community-based Integrated Care System 21-Items (DASC-21) is an effective tool for CGA.…”

Section: Introductionmentioning

confidence: 99%

Association between Cognitive Impairment Severity and Polypharmacy in Older Patients with Atrial Fibrillation: A Retrospective Study Using Inpatient Data from a Specialised Geriatric Hospital

Shimazaki,

Kishimoto,

Ishikawa

et al. 2024

Geriatrics

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This study aimed to investigate the association between cognitive impairment and polypharmacy in patients with atrial fibrillation prone to cognitive decline, and to elucidate if the Dementia Assessment Sheet for Community-based Integrated Care System 21-Items (DASC-21) severity classification indicates drug adjustment. This retrospective cohort study used the DASC-21 and Diagnosis Procedure Combination data at a specialised geriatric hospital with patients hospitalised between April 2019 and March 2022. The association between cognitive severity evaluated using the DASC-21 and polypharmacy was investigated using a multivariate logistic regression model. Data of 1191 inpatients (44.3% aged ≥85 years, 49.0% male) were analysed. Compared with severe cognitive impairment, mild (odds ratio [OR]: 3.33, 95% confidence interval [CI]: 1.29–8.57) and moderate (OR: 2.46, 95% CI: 1.06–5.72) impairments were associated with concurrent use of ≥6 medications. Antithrombotics were related to polypharmacy. The ORs did not change with 6, 8, or 10 medications (2.11 [95% CI: 1.51–2.95, p < 0.001], 2.42 [95% CI: 1.79–3.27, p < 0.001], and 2.01 [95% CI: 1.46–2.77, p < 0.001], respectively). DASC-21 severity was associated with polypharmacy in patients with atrial fibrillation, with a trend toward decreased polypharmacy from moderate to severe. The DASC-21 may serve as an indicator for drug adjustment in clinical practice.

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Association between comprehensive geriatric assessment and polypharmacy at discharge in patients with ischaemic stroke: A nationwide, retrospective, cohort study

Cited by 8 publications

References 31 publications

Association between subjective physical function and occurrence of new fractures in older adults: A retrospective cohort study

Association between subjective physical function and occurrence of new fractures in older adults: A retrospective cohort study

Association between the type of hypnotic drug and in‐hospital fractures in older patients with neurocognitive disorders: A case–control study using a nationwide database

Association between Cognitive Impairment Severity and Polypharmacy in Older Patients with Atrial Fibrillation: A Retrospective Study Using Inpatient Data from a Specialised Geriatric Hospital

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