Deprescribing psychotropic medications is associated with improvements in activities of daily living in post‐stroke patients

Kose, Eiji; Matsumoto, Ayaka; Yoshimura, Yoshihiro

doi:10.1111/ggi.14811

Cited by 2 publications

References 53 publications

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The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta‐analysis

Quek,

Page,

Lee

et al. 2024

Brit J Clinical Pharma

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AimsPrevious systematic reviews suggest that deprescribing may improve survival, particularly in frail older people. Evidence is rapidly accumulating, suggesting a need for an updated review of the literature.MethodsWe updated a 2016 systematic review and meta‐analysis to include studies published from inception to 26 April 2024 from specified databases. Studies in which older people had at least one medication deprescribed were included and grouped by study designs and targeted medications. The risk of bias was assessed using the Cochrane tool and the Newcastle‐Ottawa tool. Odds ratios (OR) or mean differences were calculated as the effect measures using either the Mantel–Haenszel or generic inverse‐variance method with fixed‐ or random‐effects meta‐analyses. The primary outcome was mortality. Secondary outcomes were adverse drug withdrawal events, physical health, cognitive function, quality of life and effect on medication regimen. Subgroup analyses were performed based on age and intervention types.ResultsA total of 259 studies (reported in 286 papers) were included in this updated review. Deprescribing polypharmacy did not result in a significant reduction in mortality in both randomized (OR 0.96, 95% confidence interval [CI] 0.84–1.09) and non‐randomized studies (OR 0.70, 95% CI 0.36–1.38). Further subgroup analyses of randomized studies on deprescribing polypharmacy demonstrated a significant reduction in mortality in the young old (aged 65–79) (OR 0.71, 95% CI 0.51–0.99) and when patient‐specific interventions were applied (OR 0.79, 95% CI 0.63–0.99).ConclusionsDeprescribing can be achieved with potentially important benefits in terms of improved survival, particularly when patient‐specific interventions are applied and initiated early in the young old.

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The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta‐analysis

Quek,

Page,

Lee

et al. 2024

Brit J Clinical Pharma

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Psychotropic Polypharmacy Impairs Walking Independence in Post-Stroke Patients

Matsumoto,

Yoshimura,

Nagano

et al. 2024

Preprint

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Background Psychotropic drugs are associated with adverse outcomes in older adults. However, evidence on the effect of psychotropic use on walking ability in post-stroke patients is lacking. Aim This study examined the association between psychotropic medication use and walking independence in post-stroke patients. Methods This retrospective cohort study included stroke patients admitted for convalescent rehabilitation at a Japanese hospital between 2020–2022. Psychotropic medications (benzodiazepines, hypnotics, antipsychotics, antidepressants) prescribed at admission were recorded. The primary outcome was walking independence at discharge, defined as a Functional Independence Measure (FIM) walk score ≥ 6. Logistic regression analyses examined the association between the number of psychotropic drugs and walking independence, adjusting for potential confounders. Results Of the 709 patients enrolled, 559 (mean age 75.5 years, 52.8% male) were included in the analysis. At admission, 25.4% of patients used psychotropic drugs. In the adjusted analysis, the number of psychotropic medications was independently associated with lower walking independence at discharge (OR 0.620, 95% CI 0.428–0.897, p = 0.011). Hypnotic use specifically showed a negative impact on walking independence (OR 0.331, 95% CI 0.154–0.708, p = 0.004). However, psychotropic drug use was not significantly associated with improvement in FIM-motor scores. Conclusion Greater psychotropic polypharmacy at admission, particularly with hypnotics, was associated with reduced likelihood of achieving walking independence after stroke rehabilitation. Judicious use of psychotropic medications may be warranted when ambulation is a critical goal for older post-stroke patients.

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Deprescribing psychotropic medications is associated with improvements in activities of daily living in post‐stroke patients

Cited by 2 publications

References 53 publications

The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta‐analysis

The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta‐analysis

Psychotropic Polypharmacy Impairs Walking Independence in Post-Stroke Patients

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