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. 2024 Nov 1;79(11):glae207.
doi: 10.1093/gerona/glae207.

Impact of Hospitalizations on Problematic Medication Use Among Community-Dwelling Persons With Dementia

W James Deardorff  1   2 , Bocheng Jing  1   2 , Matthew E Growdon  1   2 , Leah J Blank  3 , Tasce Bongiovanni  4 , Kristine Yaffe  2   5 , W John Boscardin  1   2 , Kenneth S Boockvar  6   7 , Michael A Steinman  1   2
Affiliations

Impact of Hospitalizations on Problematic Medication Use Among Community-Dwelling Persons With Dementia

W James Deardorff et al. J Gerontol A Biol Sci Med Sci. .

Abstract

Background: Hospitalizations are frequently disruptive for persons with dementia (PWD) in part due to the use of potentially problematic medications for complications such as delirium, pain, and insomnia. We sought to determine the impact of hospitalizations on problematic medication prescribing in the months following hospitalization.

Methods: We included community-dwelling PWD in the Health and Retirement Study aged ≥66 with a hospitalization from 2008 to 2018. We characterized problematic medications as medications that negatively affect cognition (strongly anticholinergics/sedative-hypnotics), medications from the 2019 Beers criteria, and medications from STOPP-V2. To capture durable changes, we compared problematic medications 4 weeks prehospitalization (baseline) to 4 months posthospitalization period. We used a generalized linear mixed model with Poisson distribution adjusting for age, sex, comorbidity count, prehospital chronic medications, and timepoint.

Results: Among 1 475 PWD, 504 had a qualifying hospitalization (median age 84 (IQR = 79-90), 66% female, 17% Black). There was a small increase in problematic medications from the baseline to posthospitalization timepoint that did not reach statistical significance (adjusted mean 1.28 vs 1.40, difference 0.12 (95% CI -0.03, 0.26), p = .12). Results were consistent across medication domains and certain subgroups. In one prespecified subgroup, individuals on <5 prehospital chronic medications showed a greater increase in posthospital problematic medications compared with those on ≥5 medications (p = .04 for interaction, mean increase from baseline to posthospitalization of 0.25 for those with <5 medications (95% CI 0.05, 0.44) vs. 0.06 (95% CI -0.12, 0.25) for those with ≥5 medications).

Conclusions: Hospitalizations had a small, nonstatistically significant effect on longer-term problematic medication use among PWD.

Keywords: Medication overuse; Polypharmacy; Potentially inappropriate medication.

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Conflict of interest statement

The authors report no conflicts of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Robert Wood Johnson Foundation, Veterans Affairs, or United States government.

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