Potentially Inappropriate Prescribing in Long-Term Care and its Relationship With Probable Delirium

Colleen Webber; Christina Milani; Lise M Bjerre; Peter G Lawlor; Shirley H Bush; Christine L Watt; Michael Pugliese; Frank Knoefel; Genevieve Casey; Franco Momoli; Kednapa Thavorn; Peter Tanuseputro

doi:10.1016/j.jamda.2023.08.019

Potentially Inappropriate Prescribing in Long-Term Care and its Relationship With Probable Delirium

J Am Med Dir Assoc. 2024 Jan;25(1):130-137.e4. doi: 10.1016/j.jamda.2023.08.019. Epub 2023 Sep 21.

Authors

Affiliations

¹ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; ICES, Ontario, Canada. Electronic address: cowebber@ohri.ca.
² Bruyère Research Institute, Ottawa, Ontario, Canada.
³ ICES, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Institut du savoir Montfort, Ottawa, Ontario, Canada.
⁴ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Bruyère Research Institute, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Ontario, Canada.
⁷ Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁸ Division of Geriatrics, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁹ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
¹⁰ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
¹¹ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; ICES, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

PMID: 37743042
DOI: 10.1016/j.jamda.2023.08.019

Abstract

Objectives: This study examined potentially inappropriate prescribing (PIP) of medication and its association with probable delirium among long-term care (LTC) residents in Ontario, Canada.

Design: Population-based cross-sectional study using provincial health administrative data, including LTC assessment data via the Resident Assessment Instrument-Minimum Dataset version 2.0 (RAI-MDS 2.0).

Setting and participants: LTC residents in Ontario between January 1, 2016, and December 31, 2019.

Methods: We used residents' first RAI-MDS 2.0 assessment in the study period as the index assessment. Probable delirium was identified via the delirium Clinical Assessment Protocol. Medication use in the 2 weeks preceding assessment was captured using medication claims data. PIP was measured using the STOPP/START criteria and 2015 Beers criteria, with residents classified as having 0, 1, 2, or 3+ instances of PIP. Relationships between PIP and probable delirium was assessed via bivariate and multivariable logistic regression models.

Results: The study population included 171,190 LTC residents (mean age 84.5 years, 66.8% female, 62.9% with dementia). More than half (51.8%) of residents had 1+ instances of PIP and 21% had 3+ instances of PIP according to the STOPP/START criteria; PIP prevalence was slightly lower when assessed using Beers criteria (36.5% with 1+, 11.1% with 3+). Overall, 3.7% of residents had probable delirium. The prevalence of probable delirium increased as the number of instances of PIP increased, with residents with 3+ instances of STOPP/START PIP being 1.66 times more likely (95% CI 1.56-1.77) to have probable delirium compared to those with no instances of PIP. Similar findings were observed when PIP was measured using the Beers criteria. Central nervous system (CNS)-related PIP criteria showed a stronger association with probable delirium than non-CNS-related PIP criteria.

Conclusions and implications: This population-based study highlighted that PIP was highly prevalent in long-term care residents and was associated with an increased prevalence of probable delirium.

Keywords: Nursing homes; delirium; inappropriate prescribing; prescription drugs.

MeSH terms

Aged, 80 and over
Cross-Sectional Studies
Delirium* / drug therapy
Delirium* / epidemiology
Female
Humans
Inappropriate Prescribing*
Long-Term Care
Male
Ontario / epidemiology