Is anticholinergic and sedative drug burden associated with postdischarge institutionalization in community-dwelling older patients acutely admitted to hospital? A Norwegian registry-based study

Abstract

Purpose: Investigate the association between anticholinergic (AC) and sedative (SED)drug burden before hospitalization and postdischarge institutionalization (PDI) incommunity-dwelling older patients acutely admitted to hospital.<p><p>Methods: A cross-sectional study using data from the Norwegian Patient Registryand the Norwegian Prescription Database. We studied acutely hospitalizedcommunity-dwelling patients≥70 years during 2013 (N=86 509). Patients acutelyadmitted to geriatric wards underwent subgroup analyses (n=1715). We calculateddrug burden by the Drug Burden Index (DBI), use of AC/SED drugs, and the number of AC/SED drugs. Piecewise linearity of DBI versus PDI and a knot point(DBI=2.45) was identified. Statistical analyses included an adjusted multivariable logistic regression model.<p>Results: In the total population, 45.4% were exposed to at least one AC/SED drug,compared to 52.5% in the geriatric subgroup. AC/SED drugs were significantly asso-ciated with PDI. The DBI with odds ratios (ORs) of 1.11 (95% CI 1.07–1.15) forDBI < 2.45 and 1.08 (95% CI 1.04–1.13) for DBI≥2.45. The number of AC/SEDdrugs with OR of 1.07 (95% CI 1.05–1.09). The AC component of DBI with OR 1.23and the number of AC drugs with OR 1.13. In the subgroup, ORs were closer to 1 forAC drugs.<p>Conclusions: The use of AC/SED drugs was highly prevalent in older patients beforeacute hospital admissions, and significantly associated with PDI. The number, or justusing AC/SED drugs, gave similar associations with PDI compared to applying theDBI. Using AC drugs showed higher sensitivity, indicating that to reduce the risk ofPDI, a clinical approach could be to reduce the number of AC drugs.