Use of medicines that may precipitate delirium prior to hospitalisation in older Australians with delirium: An observational study

Kassie, Gizat M.; Ellett, Lisa M. Kalisch; Nguyen, Tuan Anh; Roughead, Elizabeth E.

doi:10.1111/ajag.12608

Cited by 10 publications

(8 citation statements)

References 29 publications

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“…4,7,11 This pooled result also demonstrated that older patients had an increased risk of developing POD, which may be due to poor physical condition, more comorbidities, and complex medication use in senile patients. [32][33][34] Unfortunately, our results indicated high heterogeneity in age. After subgroup analysis, heterogeneity decreased by 80%, but the significance did not change, which can be explained by the small sample size.…”

Section: Demographic Predictorscontrasting

confidence: 69%

“…Age has been well‐established as an independent predisposing factor for POD 4,7,11 . This pooled result also demonstrated that older patients had an increased risk of developing POD, which may be due to poor physical condition, more comorbidities, and complex medication use in senile patients 32–34 . Unfortunately, our results indicated high heterogeneity in age.…”

Section: Discussionmentioning

confidence: 52%

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Associated factors for postoperative delirium following major abdominal surgery: A systematic review and meta‐analysis

Liu

Wang

et al. 2023

Int J Geriat Psychiatry

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Objectives Postoperative delirium (POD) is a common postsurgical complication. The early identification of its risk factors is the first step toward reducing POD. The predictive factors for POD in patients after major abdominal surgery remain obscure. Therefore, this meta‐analysis aimed to comprehensively summarize the risk factors of POD after major abdominal surgery. Methods POD studies published between January, 1900 and June 2022 were obtained by searching PubMed, Cochrane Library, Web of Science, Embase, and Medline. Two authors independently reviewed the studies to extract the risk factors and assessed the quality of related articles using the Newcastle‐Ottawa Scale. Data were recorded, and a meta‐analysis was performed using Review Manager version 5.4.1. Results Ten studies including total 2900 patients undergoing major abdominal surgery, were eligible for analysis, 608 of whom developed POD, for a cumulative incidence of 21%. This pooled analysis suggested the statistically significant risk factors for POD were age, higher American Society of Anesthesiologists grade, lower preoperative Mini‐Mental State Examination score, cognitive impairment, preoperative Katz‐ADL score <6, preoperative and postoperative hypoalbuminemia, lower preoperative insulin‐like growth factor‐1 levels, and longer duration of anesthesia. Conclusion POD is common in patients undergoing major abdominal surgery. This meta‐analysis identified risk factors that may aid the early detection of POD and play a prominent role in preventing POD.

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Section: Demographic Predictorscontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 52%

Associated factors for postoperative delirium following major abdominal surgery: A systematic review and meta‐analysis

Liu

Wang

et al. 2023

Int J Geriat Psychiatry

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“…Among the most investigated mechanisms is cholinergic dysfunction, which may contribute to some of the manifestations known to be present in delirium, such as cognitive deficits associated with memory loss [7,8]. Identification and reversal of clinical conditions associated with delirium are the first step to treat the disturbance, as well as mitigation of environmental factors and the exposure to deliriogenic drugs [9]. Non-pharmacological approaches should be provided in order to prevent and manage the neuropsychiatric symptoms related to delirium, such as: avoid the use of physical restraints, catheters, and bed alarms, ambulate patient, address sensory impairment, encourage exposure to bright light during the day, among others [8].…”

Section: Definition Diagnosis and Treatmentmentioning

confidence: 99%

“…Thus, in order to prevent the development of delirium resulting from the use of drugs, it became necessary to develop risk management plans, which is currently a prerequisite for a good pharmacovigilance service [9].…”

Section: Delirium In Older Peoplementioning

confidence: 99%

Drug-Induced Delirium among Older People

Varallo¹,

Oliveira²,

Zanetti³

et al. 2021

New Insights Into the Future of Pharmacoepidemiology and Drug Safety

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Although underdiagnosed, delirium is a common and potentially preventable problem in older patients, being associated with morbimortality. Drugs have been associated with the development of delirium in the geriatric population and may be considered the most easily reversible trigger. Polypharmacy, prescription of deliriogenic, anticholinergic and potentially inappropriate drugs are contributing factors for the occurrence of the disturb. Furthermore, changes in pharmacokinetic and pharmacodynamic parameters, which are intrinsic of the aged process, may contribute for cognitive impairment. Identification and reversal of clinical conditions associated with delirium are the first step to treat the disturbance, as well as mitigation of environmental factors and the exposition to deliriogenic drugs. Current evidence does not support the prescription of antipsychotics and benzodiazepines for the treatment of delirium. However, the judicious use of first- or second-generation antipsychotics can be considered in severe cases. Multi-component non-pharmacological, software-based intervention to identify medications that could contribute to delirium, predictive models, tools, training of health professionals and active actions of pharmacovigilance may contribute to the screening, prevention, and management of delirium in older people. Besides, it is also important to improve the report of drug-induced delirium in medical records, to develop properly risk management plans and avoid cascade iatrogenesis.

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“…Older adults are at an increased risk of delirium because of ageing, multiple comorbidities, frailty, and polypharmacy 11,16–18 . Medication‐induced delirium is a modifiable risk factor, and studies have shown several individual medications can contribute to delirium in older adults 19–22 . Some of the most common medications classes associated with delirium include antimicrobials, antihistamines, antihypertensives, anticholinergics, antidepressants, antipsychotics benzodiazepines, diuretics, opioids, and nonsteroidal anti‐inflammatory medications 23–27 .…”

Section: Introductionmentioning

confidence: 99%

Identifying frequent drug combinations associated with delirium in older adults: Application of association rules method to a case‐time‐control design

Chyou

Nishtala

2021

Pharmacoepidemiology and Drug

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Background Older adults are at an increased risk of delirium because of age, polypharmacy, multiple comorbidities, frailty, and acute illness. Although medication‐induced delirium in older adults is well understood, limited population‐level evidence is available, particularly on combinations of medications associated with delirium in older adults. Objectives We aimed to apply association rule analysis to identify drug combinations contributing to delirium risk in adults aged 65 and older using a case‐time‐control design. Method We sourced a nationwide representative sample of New Zealander's aged ≥65 years from the pharmaceutical collections and hospital discharge information. Prescription records (2005–2015) were obtained from New Zealand pharmaceutical collections (Pharms). Medication exposures were coded as binary variables (exposed vs. not exposed) at the individual drug level. All medications, including antimicrobials, antihistamines, diuretics, opioids, and nonsteroidal anti‐inflammatory medications, were considered drugs of interest. The first‐time coded diagnosis of delirium was extracted from the National Minimal Dataset (NMDS). A unique patient identifier linked the prescription dataset to the event dataset to set up a case‐time‐control cohort, indexed at the first delirium event. Association rules were then applied to identify frequent drug combinations in the case and the control periods (l‐day with a 35‐day washout period) that are statistically associated with delirium, and the association was tested by computing a time‐trend adjusted matched odds‐ratio (MOR) and its 95% confidence interval (CI). Results We identified 28 503 individuals (mean age 84.1 years) from 2005 to 2015 with delirium. Our combined association rule and case‐time‐control analysis identified several drug classes, including antipsychotics, benzodiazepines, opioids, and diuretics associated with delirium. Our analysis also identified frequently used drug combinations that are associated with delirium. Examples include combined exposures to quetiapine and furosemide (MOR = 6.17; 95%CI = [2.05–18.54]), haloperidol (MOR = 4.81; 95%CI = [3.16–6.69]), combined exposures to furosemide, omeprazole, and lorazepam (MOR = 3.94; 95%CI = [3.03–5.10]), and fentanyl exposure (MOR = 3.46; 95%CI [2.05–9.21]). Conclusion The association rule method applied to a case‐time‐control design is a novel approach to identifying drug combinations contributing to delirium with adjustment for any temporal trends in exposures. The study provides new insight into the combination of medicines linked to delirium.

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Use of medicines that may precipitate delirium prior to hospitalisation in older Australians with delirium: An observational study

Cited by 10 publications

References 29 publications

Associated factors for postoperative delirium following major abdominal surgery: A systematic review and meta‐analysis

Associated factors for postoperative delirium following major abdominal surgery: A systematic review and meta‐analysis

Drug-Induced Delirium among Older People

Identifying frequent drug combinations associated with delirium in older adults: Application of association rules method to a case‐time‐control design

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