Impact of Polypharmacy on Occurrence of Delirium in Elderly Emergency Patients

Hein, C.; Forgues, Adrien; Piau, Antoine; Sommet, Agnès; Vellas, Bruno; Nourhashémi, Fati

doi:10.1016/j.jamda.2014.08.012

Cited by 126 publications

(82 citation statements)

References 46 publications

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“…Dementia and age are widely recognized risk factors for delirium in older hospitalized patients, and our findings confirm previous results in other settings [13, 19, 27]. On the other hand, although polypharmacy in older hospitalized patients is associated with delirium in many studies [10, 28, 29], our study did not confirm this association. This could be consistent with data by Moorey et al [30], showing that the number of prescribed drugs inversely correlated with age.…”

Section: Discussionsupporting

confidence: 50%

Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia

Gual

Morandi

Pérez

et al. 2018

Dement Geriatr Cogn Disord

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Background: Delirium research is poorly studied in postacute care, a growing setting due to aging populations, as well as in dementia, a critical risk factor for delirium and particularly prevalent in postacute care. We investigated risk factors for delirium and its outcomes in older adults with and without dementia admitted to a subacute care unit (SCU) after exacerbated chronic conditions. Methods: This is a prospective cohort study including patients ≥65 years old admitted to an SCU for 12 months. We collected demographics, comprehensive geriatric assessments, and presence of dementia and delirium at admission. Outcomes included discharge to previous living situation, mortality, and functional evolution. Due to the high prevalence of dementia, a subgroup analysis was performed to investigate specific risk factors for delirium and related outcomes. Results: Of 909 patients (mean age [±SD] 85.8 ± 6.7; 60% women, 47.5% with dementia), 352 (38.7%) developed delirium. The main risk factor for delirium was dementia (HR [95% CI] 5.2 [3.5–7.7]); age, functional status, and urinary tract infections were also independently associated with delirium. In dementia patients, only age (HR [95% CI] 1.0 [1.004–1.1]) and being male (HR [95% CI] 1.7 [1.04–2.6]) were associated with delirium. Delirium was associated with greater mortality (10.8 vs. 3.9%; p < 0.001) and greater functional decline in the entire sample (–12.3 vs. –6.4 Barthel index points; p < 0.001). In the dementia subgroup, patients with delirium experienced greater functional loss (p = 0.013) and less functional recovery (p = 0.025). Conclusions: In older patients admitted to postacute care, dementia is the main risk factor for delirium, and delirium carries worse clinical and functional outcomes. In patients with dementia, delirium is also relevant, since it entails a functional loss at admission and lower functional recovery.

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Section: Discussionsupporting

confidence: 50%

Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia

Gual

Morandi

Pérez

et al. 2018

Dement Geriatr Cogn Disord

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“…The high prevalence of polypharmacy is of major concern and may contribute to multiple harmful outcomes in older hospitalized adults such as poor medication adherence, adverse drug events, and high healthcare use and costs . Polypharmacy has been found to be associated with the development of long‐term cognitive impairment, delirium, falls, urinary incontinence, and unintentional weight loss . Thus, polypharmacy may contribute to the worsening of syndromes or the development of new syndromes.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, change in the total number of prescribed medications was monitored from hospital to SNF discharge as part of this study. Polypharmacy was defined as five or more medications and hyperpolypharmacy as 10 or more medications …”

Section: Methodsmentioning

confidence: 99%

Stability of Geriatric Syndromes in Hospitalized Medicare Beneficiaries Discharged to Skilled Nursing Facilities

Simmons

Bell

Saraf

et al. 2016

J American Geriatrics Society

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Objectives The purpose of this study was to assess multiple geriatric syndromes in a sample of older hospitalized patients discharged to skilled nursing facilities and, subsequently, to home to determine the prevalence and stability of each geriatric syndrome at the point of these care transitions. Design Descriptive, prospective study. Setting One large university-affiliated hospital and four area SNFs. Participants Fifty-eight hospitalized Medicare beneficiaries discharged to SNF. Measurements Research personnel conducted standardized assessments of the following geriatric syndromes at hospital discharge and two weeks following SNF discharge to home: cognitive impairment, depression, incontinence, unintentional weight loss, loss of appetite, pain, pressure ulcers, history of falls, mobility impairment and polypharmacy. Results The average number of geriatric syndromes per patient was 4.4 (± 1.2) at hospital discharge and 3.8 (±1.5) following SNF discharge. There was low to moderate stability for most syndromes. On average, participants had 2.9 syndromes that persisted across both care settings, 1.4 syndromes that resolved, and 0.7 new syndromes that developed between hospital and SNF discharge. Conclusion Geriatric syndromes were prevalent at the point of each care transition but also reflected significant within-individual variability. These findings suggest that multiple geriatric syndromes present during a hospital stay are not transient nor are most syndromes resolved prior to SNF discharge. These results underscore the importance of conducting standardized screening assessments at the point of each care transition and effectively communicating this information to the next provider to support the management of geriatric conditions.

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“…It has been shown that polypharmacy caused by multimorbidity in the elderly is associated with an exponential increase of the risk of adverse effects [4,5]. For example, it increases the risk of falls [6,7], delirium [8], bleeding complications [9], dizziness, and cognitive impairment [10], and may ultimately lead to an increased risk of mortality [11,12]. The use of drugs that have a favorable safety profile and a low potential for drug interactions is therefore essential in this particularly vulnerable patient population [13].…”

Section: Introductionmentioning

confidence: 99%

Phytopharmaceutical treatment of anxiety, depression, and dementia in the elderly: evidence from randomized, controlled clinical trials

Kasper

2015

Wien Med Wochenschr

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Based on subgroup analyses of randomized, controlled clinical trials, we review the efficacy of three phytopharmaceutical drugs, respectively of the corresponding active substances silexan® (WS® 1265, lavender oil) in anxiety disorders, WS® 5570 (Hypericum extract) in major depression, and EGb 761® (Ginkgo biloba extract) in Alzheimer, vascular, or mixed type dementia, in elderly patients aged ≥ 60 years. Four trials were eligible in each indication. Meta-analyses and analyses based on pooled raw data showed that the three drugs were significantly superior to placebo in the elderly subset, and that their treatment effects reflected in the main outcome measures (Hamilton Anxiety scale, Hamilton Depression scale, Neuropsychiatric Inventory) were comparable with those observed in the original trials without age restrictions. The results confirm the efficacy of the three herbal active substances in elderly patients of ≥ 60 years of age. In anxiety, depression, and dementia, they thus represent efficacious and well-tolerated alternatives to synthetic drugs.

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Impact of Polypharmacy on Occurrence of Delirium in Elderly Emergency Patients

Cited by 126 publications

References 46 publications

Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia

Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia

Stability of Geriatric Syndromes in Hospitalized Medicare Beneficiaries Discharged to Skilled Nursing Facilities

Phytopharmaceutical treatment of anxiety, depression, and dementia in the elderly: evidence from randomized, controlled clinical trials

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