Associations of polypharmacy and drugs with sedative or anticholinergic properties with the risk of long‐term care needs certification among older adults in Japan: A population‐based, nested case–control study

Abstract

Aim To estimate the risk of disability associated with high‐risk prescribing, such as polypharmacy and drugs with sedative or anticholinergic properties, using long‐term care needs certification as a proxy of incident disability. Methods A case–control study nested within a cohort of older adults (89% aged ≥65 years) was carried out between 2014 and 2019 using the combined medical claims and long‐term care needs certification database of Tsukuba City, Japan. We identified 2123 cases who received their first long‐term care certification, and matched them to 40 295 controls based on age, sex, residential area and observation period (≥36 months). The risk of long‐term care needs certification associated with high‐risk prescribing exposure 7–30 months before the index month was estimated using conditional logistic regression adjusting for baseline comorbidities and health service use. Results Polypharmacy (5–9 drugs; adjusted odds ratio [aOR] 1.32, 95% confidence interval [95% CI] 1.18–1.47), hyperpolypharmacy (≥10 drugs; aOR 1.87, 95% CI 1.57–2.23) and cumulative dose of drugs with sedative or anticholinergic properties (1–364 defined daily dose [DDD]; aOR 1.07, 95% CI 0.97–1.19; 365–729 DDD; aOR 1.25, 95% CI 1.07–1.45; ≥730 DDD; aOR 1.33, 95% CI 1.19–1.62) had dose–response relationships with long‐term care certification risks. Conclusions High‐risk prescribing was associated with the risk of long‐term care needs certification in the general older population. Further studies are warranted to examine whether a decrease in prescribing drugs with sedative or anticholinergic properties could reduce the long‐term care burden on society. Geriatr Gerontol Int 2022; 22: 497–504.

Comparative risk of fracture in community‐dwelling older adults initiating suvorexant versus Z‐drugs: Results from LIFE study

“…The certification is a prerequisite for receiving LTC services in Japan; individuals begin to receive these services once they obtain the certification. 33 LTC needs certification has been shown to be correlated with the Barthel Index. 34 Therefore, we retrieved the most recent information on LTC needs certification to adjust for activities of daily living (ADL) at baseline.…”

“…Finally, we restricted the study population to individuals with available information on LTC needs certification. The certification is a prerequisite for receiving LTC services in Japan; individuals begin to receive these services once they obtain the certification 33 . LTC needs certification has been shown to be correlated with the Barthel Index 34 .…”

Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review

“…Full‐text articles were sought and screened for 316 articles that appeared to meet the inclusion criteria. Seventy studies 6,13–81 were included in the systematic review (Figure 1).…”

Changes in chronic disease medications after admission to a Geriatric Health Services Facility: A multi-center prospective cohort study

“…[6,7] Moreover, polypharmacy is associated with frailty [8] and the risk of being certified as requiring long-term care. [9] Therefore, older adults who received polypharmacy are required for medication review and deprescribing if appropriate. [10]…”

“…[6,7] Moreover, polypharmacy is associated with frailty [8] and the risk of being certified as requiring long-term care. [9] Therefore, older adults who received polypharmacy are required for medication review and deprescribing if appropriate. [10] Medicine Nursing home (or long-term care facility) residents often have multiple chronic diseases and tend to receive complex regimen of pharmacotherapies.…”