Hospitalisation for medication misadventures among older adults with and without dementia: A 5‐year retrospective study

Abstract

Objectives To compare rates and trends in hospital admissions due to medication misadventure for older adults (≥65 years) with and without dementia. Methods A retrospective analysis of hospital admissions that occurred between 2012 and 2016, for medication misadventures among older adults living in regional Australia. Results Medication misadventures contributed to 10 555 (4.6%) of the total 228 165 admissions for older adults over the study period. Among these admissions, older adults with dementia were three times more likely to be hospitalised with medication misadventures (14.0%), than their non‐dementia counterparts (4.2%). Medication misadventures relating to “anticoagulants” and “opioids/related analgesics” accounted for the majority of admissions (24.3% dementia vs 30.7% non‐dementia). Conclusions This study highlights that the proportion of older adults hospitalised for a medication misadventure is much higher among those with dementia, than those without dementia. Strategies should target older adults, and especially those with dementia, to reduce medication‐related harm and improve patient safety.

Outcomes of Medication Misadventure Among People With Cognitive Impairment or Dementia: A Systematic Review and Meta-analysis

“…The studies were conducted in Australia (n = 2), 49,50 Sweden (n = 2), 45,51 8 European countries (n = 1), 46 7 European Union countries, Israel (n = 1), 50 Finland (n = 1), 47 France (n = 1), 51 the United States of America and Canada (n = 1), 55 and the United Kingdom (n = 1). 48 Five studies were conducted in institutionalized settings (hospitals and nursing homes), 46,47,50,52,53 3 in community-dwelling/ ambulatory patients, 48,49,51 and 1 in both a community and institutional setting 45 ; 1 study used data from pharmacovigilance centers of the United States and Canada. 55 There were 5 prospective [46][47][48][49]53 and 5 retrospective studies.…”

“…55 There were 5 prospective [46][47][48][49]53 and 5 retrospective studies. 45,[50][51][52]55 The sample sizes of people with cognitive impairment/dementia ranged from 425 to 10 852 in the included studies.…”

“…The majority of studies (n = 6) included people with dementia [45][46][47]50,51,55 ; 3 had people with cognitive impairment or dementia 48,49,53 ; and 1 included people with cognitive impairment. 52 Among the studies, 60% (n = 6) included people aged ≥65 years, 46,48,[50][51][52][53] and 2 studies had cutoff values of ≥60 years 45 and ≥70 years, 47 respectively. Two studies did not specify any criteria for age 49,55 ; however, the participants had a mean age of 77.6 years in one of them.…”

“…49 Among the 10 studies, there were 5 related to PIMs [45][46][47][48][49] ; 2 reported on a combination of MEs and ADEs, 50,53 2 on ADEs, 51,55 and 1 on drug interactions. 52 The quality of studies, according to the JBI Critical Appraisal Checklist, was high for 5 studies 45,[47][48][49]51 and moderate for the remaining 5 studies 46,50,52,53,55 (Supplemental Tables 4 and Table 5).…”

“…Rivastigmine had the highest association with mortality, followed by donepezil and galantamine (Supplemental Table 6). Six studies reported that hospitalization outcome was associated with a medication misadventure, of which 3 articles were related to the use of PIMs, [45][46][47] 2 articles included MEs and ADEs, 50,53 and 1 studied ADEs. 51 Relevant data were extracted from the 3 articles examining PIMs.…”