Medications associated with geriatric syndromes and their prevalence in older hospitalized adults discharged to skilled nursing facilities

Abstract

Background More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than three geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. Objectives Develop a list of medications associated with geriatric syndromes and describe their prevalence in patients discharged from acute care to skilled nursing facilities (SNFs) Design Literature review and multidisciplinary expert panel discussion, followed by cross-sectional analysis. Setting Academic Medical Center in the United States Participants 154 hospitalized Medicare beneficiaries discharged to SNFs Measurements Development of a list of medications that are associated with six geriatric syndromes. Prevalence of the medications associated with geriatric syndromes was examined in the hospital discharge sample. Results A list of 513 medications was developed as potentially contributing to 6 geriatric syndromes: cognitive impairment, delirium, falls, reduced appetite or weight loss, urinary incontinence, and depression. Medications included 18 categories. Antiepileptics were associated with all syndromes while antipsychotics, antidepressants, antiparkinsonism and opioid agonists were associated with 5 geriatric syndromes. In the prevalence sample, patients were discharged to SNFs with an overall average of 14.0 (±4.7) medications, including an average of 5.9 (±2.2) medications that could contribute to geriatric syndromes, with falls having the most associated medications at discharge, 5.5 (±2.2). Conclusions Many commonly prescribed medications are associated with geriatric syndromes. Over 40% of all medications ordered upon discharge to SNFs were associated with geriatric syndromes and could be contributing to the high prevalence of geriatric syndromes experienced by this population.

Frequency and coincidence of geriatric syndromes according to age groups: single-center experience in Turkey between 2013 and 2017

“…In clinical practice, these conditions, such as cognitive impairment, falls, frailty, delirium, gait disturbances, incontinence, malnutrition, pain, polypharmacy, pressure ulcers, sarcopenia, sleep problems, and tremor, are named geriatric syndromes, and geriatricians play an important role in diagnoses and management of them. 2 , 3 On the other hand, clinicians other than geriatricians taking care of older people, such as primary physicians, cardiologists, oncologists, and neurologists, should be aware of these syndromes.…”

To Drug or Not to Drug: The Geriatrician Dilemma of Polypharmacy

“…Five or more prescribed drugs were used by 36% of participants. Moreover, in another report of Medicare beneficiaries admitted to a nursing facility after hospital discharge, an average of 14 medications were used by patients (9). At least 30% of these drugs showed side effects hazardous to 5 geriatric syndromes evaluated in this study.…”

Improving Care Transitions for Hospitalized Veterans Discharged to Skilled Nursing Facilities: A Focus on Polypharmacy and Geriatric Syndromes

“…We recorded the total number of medications at discharge and noted the number of these medications associated with geriatric syndromes for a subset of 25 patients, which was a convenience sample. The criteria regarding association of medications with six geriatric syndromes was described previously [29]. We also monitored unplanned readmissions to the VA hospital within 30 days of discharge to SNF.…”

“… 1 The total number of patients assessed for each syndrome varied due to refusal or patient was discharged prior to completion. 2 In this subsample, we examined which medications on a patient’s list were also on our published list of 513 medications associated with six geriatric syndromes: cognitive impairment, delirium, depression, urinary incontinence, reduced appetite or weight loss, and falls [29]. …”

“…During care transitions, such as hospital and SNF discharge, prescription medications are frequently changed (e.g., started, stopped, or changed dosages), further exposing patients to medication errors, medication-related adverse events, and readmissions [27,28]. In addition, one recent study showed that hospitalized older non-Veterans discharged to SNF are prescribed an average of six medications that may contribute to or exacerbate geriatric syndromes [29].…”