Antipsychotic prescribing and drug-related readmissions in multimorbid older inpatients: a post-hoc analysis of the OPERAM population

A Bienfait; J Lagreula; M R Blum; N Rodondi; B T G M Sallevelt; W Knol; D O'Mahony; A Spinewine; B Boland; O Dalleur

doi:10.1007/s11096-024-01700-6

Antipsychotic prescribing and drug-related readmissions in multimorbid older inpatients: a post-hoc analysis of the OPERAM population

Int J Clin Pharm. 2024 Feb 17. doi: 10.1007/s11096-024-01700-6. Online ahead of print.

Authors

A Bienfait¹, J Lagreula², M R Blum^{3

4}, N Rodondi^{3

4}, B T G M Sallevelt⁵, W Knol⁶, D O'Mahony⁷, A Spinewine^{2

8}, B Boland⁹, O Dalleur^{10

2}

Affiliations

¹ Pharmacy Department, Cliniques Universitaires Saint Luc, Brussels, Belgium. adbienfait@hotmail.fr.
² Clinical Pharmacy Research Group-Louvain Drug Research Institute, UCLouvain, Brussels, Belgium.
³ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁵ Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.
⁶ Geriatric Department, University Medical Center, Utrecht, The Netherlands.
⁷ Geriatric Department, Cork University Hospital, Cork, Ireland.
⁸ Pharmacy Department, Centre Hospitalier Universitaire UCL-Namur, Université catholique de Louvain, Namur, Belgium.
⁹ Geriatric Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
¹⁰ Pharmacy Department, Cliniques Universitaires Saint Luc, Brussels, Belgium.

PMID: 38367103
DOI: 10.1007/s11096-024-01700-6

Abstract

Background: Limited data are available on characteristics associated with antipsychotic use in multimorbid older adults.

Aim: Primary: to identify patient characteristics associated with antipsychotic prescribing in a multimorbid population of older inpatients with polypharmacy. Secondary: (1) to observe if antipsychotics use during an index hospitalisation was associated with a drug related admission (DRA) within one year, and (2) to describe these cases of antipsychotic-related readmissions.

Method: This was a secondary analysis of the OPERAM randomized controlled trial. Multivariate analysis assessed the association between characteristics and comorbidities with antipsychotic use. An expert team assessed DRA occurring during the one-year follow-up.

Results: Antipsychotics were prescribed to 5.5% (n = 110) patients upon admission while 7.7% (n = 154) inpatients received antipsychotics at any time (i.e. upon admission, during hospitalisation, and/or at discharge). The most frequently prescribed antipsychotics were quetiapine (n = 152), haloperidol (n = 48) and risperidone (n = 22). Antipsychotic prescribing was associated with dementia (OR = 3.7 95%CI[2.2;6.2]), psychosis (OR = 26.2 [7.4;92.8]), delirium (OR = 6.4 [3.8;10.8]), mood disorders (OR = 2.6 [1.6;4.1]), ≥ 15 drugs a day (OR = 1.7 [1.1;2.6]), functional dependency (Activities of Daily Living score < 50/100) (OR = 3.9 [2.5;6.1]) and < 2 units of alcohol per week (OR = 2.2 [1.4;3.6]). DRA occurred in 458 patients (22.8%) within one year. Antipsychotic prescribing at any time was not associated with DRA (OR = 1.0 [0.3;3.9]) however contributed to 8 DRAs, including 3 falls.

Conclusion: In this European multimorbid polymedicated older inpatients, antipsychotics were infrequently prescribed, most often at low dosage. Besides neuro-psychiatric symptoms, risk factors for inhospital antipsychotic prescribing were lower functional status and polymedication.

Keywords: Antipsychotic agents; Drug-related admission; Multimorbidity; Older patients.