Central Nervous System-Acting Medicines and Risk of Hospital Admission for Confusion, Delirium, or Dementia
Abstract Background Most studies assessing the effect of central nervous system (CNS)-acting medicines on cognitive disturbances have focused on the use of individual medicines. The impact on cognitive function when another CNS-acting medicine is added to a patient's treatment regimen is not we...
Gespeichert in:
| Veröffentlicht in: | Journal of the American Medical Directors Association 2016-06, Vol.17 (6), p.530-534 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 534 |
|---|---|
| container_issue | 6 |
| container_start_page | 530 |
| container_title | Journal of the American Medical Directors Association |
| container_volume | 17 |
| creator | Kalisch Ellett, Lisa M., BPharm(Hons), PhD Pratt, Nicole L., BSc(Hons), PhD Ramsay, Emmae N., MClinEpid Sluggett, Janet K., BPharm(Hons), GDipClinEpid, PhD Barratt, John D., BPharm, BAppSci Roughead, Elizabeth E., BPharm, GradDip Health Promotion, MAppSc, PhD |
| description | Abstract Background Most studies assessing the effect of central nervous system (CNS)-acting medicines on cognitive disturbances have focused on the use of individual medicines. The impact on cognitive function when another CNS-acting medicine is added to a patient's treatment regimen is not well known. Objective To determine risk of hospitalization for confusion, delirium, or dementia in older people associated with increasing numbers of CNS-acting medicines taken concurrently, as well as the number of standard doses taken each day (measured as defined daily doses). Design Retrospective cohort study, from July 2011 to June 2012, using health claims data. Setting Australian veteran population. Participants A total of 74,321 community-dwelling individuals aged 65 years and over, who were dispensed at least 1 CNS-acting medicine in the year before study entry. Patients with prior hospitalization for confusion or delirium, and those with dementia or receiving palliative care, were excluded. Main outcome measure Hospitalization for confusion, delirium, or dementia. Results Over the 1-year study period, 401 participants were hospitalized with confusion, delirium, or dementia. Adjusted analyses showed the risk of hospitalization was 2.4 times greater with the use of 2 CNS-acting medicines compared with no use [incident rate ratio (IRR) 2.39, 95% confidence interval (CI) 1.79–3.19, P |
| doi_str_mv | 10.1016/j.jamda.2016.02.008 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1792538080</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1525861016001080</els_id><sourcerecordid>1792538080</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-d61388ae4763ee7c38f55ed10a32adfba4d9993f3a4978bc3af42b1dfe17292d3</originalsourceid><addsrcrecordid>eNqFkU-PFCEQxYnRuOvqJzAxHD1stwX034Mmk1l1TVZNXD0TBgpDTzfMQvcm8-2lndWDF09Q8B6P-hUhLxmUDFjzZigHNRlV8lyUwEuA7hE5Z7Xoil609eN1z-uiaxickWcpDQBZ2jdPyRlvIV81cE72W_RzVCP9gvE-LIneHtOMU7HRs_M_6Wc0TjuPiSpv6DeX9jRYeh3Swc3ZtDGTS8kFT22IdBu8Xdbqkl7h6KJbpkuaz69wyiFOPSdPrBoTvnhYL8iPD--_b6-Lm68fP203N4WuWDUXpmGi6xRWbSMQWy06W9doGCjBlbE7VZm-74UVqurbbqeFshXfMWORtbznRlyQ16d3DzHcLZhmmX-pcRyVx9yiZG3PMyXoIEvFSapjSCmilYfoJhWPkoFcKctB_qYsV8oSuMyUs-vVQ8Cym9D89fzBmgVvTwLMbd47jDJph15nmhH1LE1w_wl4949fj847rcY9HjENYYk-E5RMpmyQt-ug1zmzBoCtff0C1AakEA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1792538080</pqid></control><display><type>article</type><title>Central Nervous System-Acting Medicines and Risk of Hospital Admission for Confusion, Delirium, or Dementia</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Kalisch Ellett, Lisa M., BPharm(Hons), PhD ; Pratt, Nicole L., BSc(Hons), PhD ; Ramsay, Emmae N., MClinEpid ; Sluggett, Janet K., BPharm(Hons), GDipClinEpid, PhD ; Barratt, John D., BPharm, BAppSci ; Roughead, Elizabeth E., BPharm, GradDip Health Promotion, MAppSc, PhD</creator><creatorcontrib>Kalisch Ellett, Lisa M., BPharm(Hons), PhD ; Pratt, Nicole L., BSc(Hons), PhD ; Ramsay, Emmae N., MClinEpid ; Sluggett, Janet K., BPharm(Hons), GDipClinEpid, PhD ; Barratt, John D., BPharm, BAppSci ; Roughead, Elizabeth E., BPharm, GradDip Health Promotion, MAppSc, PhD</creatorcontrib><description>Abstract Background Most studies assessing the effect of central nervous system (CNS)-acting medicines on cognitive disturbances have focused on the use of individual medicines. The impact on cognitive function when another CNS-acting medicine is added to a patient's treatment regimen is not well known. Objective To determine risk of hospitalization for confusion, delirium, or dementia in older people associated with increasing numbers of CNS-acting medicines taken concurrently, as well as the number of standard doses taken each day (measured as defined daily doses). Design Retrospective cohort study, from July 2011 to June 2012, using health claims data. Setting Australian veteran population. Participants A total of 74,321 community-dwelling individuals aged 65 years and over, who were dispensed at least 1 CNS-acting medicine in the year before study entry. Patients with prior hospitalization for confusion or delirium, and those with dementia or receiving palliative care, were excluded. Main outcome measure Hospitalization for confusion, delirium, or dementia. Results Over the 1-year study period, 401 participants were hospitalized with confusion, delirium, or dementia. Adjusted analyses showed the risk of hospitalization was 2.4 times greater with the use of 2 CNS-acting medicines compared with no use [incident rate ratio (IRR) 2.39, 95% confidence interval (CI) 1.79–3.19, P < .001], and more than 19 times greater when 5 or more CNS-acting medicines were taken concurrently (IRR 19.35, 95% CI 11.10–33.72, P < .001). Similarly, the risk of hospitalization was significantly increased among patients taking between 1.0 and 1.9 standard doses per day (IRR 2.64, 95% CI 1.99–3.50, P < .001) and between 2.0 and 2.9 standard doses per day (IRR 3.43, 95% CI 2.07–5.69, P < .001) compared with no use. Conclusions Use of multiple CNS-acting medicines or higher doses is associated with an increased risk of hospitalization for confusion, delirium, or dementia. Health care professionals need to be alert to the contribution of CNS-acting medicines among patients presenting with confusion or delirium and consider strategies to reduce treatment burden where possible.</description><identifier>ISSN: 1525-8610</identifier><identifier>EISSN: 1538-9375</identifier><identifier>DOI: 10.1016/j.jamda.2016.02.008</identifier><identifier>PMID: 27052560</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Administrative Claims, Healthcare ; Aged ; Antipsychotic Agents - adverse effects ; Australia ; cognitive impairment ; Confusion - chemically induced ; Delirium ; Delirium - chemically induced ; dementia ; Dementia - chemically induced ; Female ; geriatrics ; Hospitalization - trends ; Humans ; Internal Medicine ; Male ; Medical Education ; psychotropics ; Retrospective Studies ; Risk Assessment</subject><ispartof>Journal of the American Medical Directors Association, 2016-06, Vol.17 (6), p.530-534</ispartof><rights>AMDA – The Society for Post-Acute and Long-Term Care Medicine</rights><rights>2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine</rights><rights>Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-d61388ae4763ee7c38f55ed10a32adfba4d9993f3a4978bc3af42b1dfe17292d3</citedby><cites>FETCH-LOGICAL-c414t-d61388ae4763ee7c38f55ed10a32adfba4d9993f3a4978bc3af42b1dfe17292d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1525861016001080$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27052560$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kalisch Ellett, Lisa M., BPharm(Hons), PhD</creatorcontrib><creatorcontrib>Pratt, Nicole L., BSc(Hons), PhD</creatorcontrib><creatorcontrib>Ramsay, Emmae N., MClinEpid</creatorcontrib><creatorcontrib>Sluggett, Janet K., BPharm(Hons), GDipClinEpid, PhD</creatorcontrib><creatorcontrib>Barratt, John D., BPharm, BAppSci</creatorcontrib><creatorcontrib>Roughead, Elizabeth E., BPharm, GradDip Health Promotion, MAppSc, PhD</creatorcontrib><title>Central Nervous System-Acting Medicines and Risk of Hospital Admission for Confusion, Delirium, or Dementia</title><title>Journal of the American Medical Directors Association</title><addtitle>J Am Med Dir Assoc</addtitle><description>Abstract Background Most studies assessing the effect of central nervous system (CNS)-acting medicines on cognitive disturbances have focused on the use of individual medicines. The impact on cognitive function when another CNS-acting medicine is added to a patient's treatment regimen is not well known. Objective To determine risk of hospitalization for confusion, delirium, or dementia in older people associated with increasing numbers of CNS-acting medicines taken concurrently, as well as the number of standard doses taken each day (measured as defined daily doses). Design Retrospective cohort study, from July 2011 to June 2012, using health claims data. Setting Australian veteran population. Participants A total of 74,321 community-dwelling individuals aged 65 years and over, who were dispensed at least 1 CNS-acting medicine in the year before study entry. Patients with prior hospitalization for confusion or delirium, and those with dementia or receiving palliative care, were excluded. Main outcome measure Hospitalization for confusion, delirium, or dementia. Results Over the 1-year study period, 401 participants were hospitalized with confusion, delirium, or dementia. Adjusted analyses showed the risk of hospitalization was 2.4 times greater with the use of 2 CNS-acting medicines compared with no use [incident rate ratio (IRR) 2.39, 95% confidence interval (CI) 1.79–3.19, P < .001], and more than 19 times greater when 5 or more CNS-acting medicines were taken concurrently (IRR 19.35, 95% CI 11.10–33.72, P < .001). Similarly, the risk of hospitalization was significantly increased among patients taking between 1.0 and 1.9 standard doses per day (IRR 2.64, 95% CI 1.99–3.50, P < .001) and between 2.0 and 2.9 standard doses per day (IRR 3.43, 95% CI 2.07–5.69, P < .001) compared with no use. Conclusions Use of multiple CNS-acting medicines or higher doses is associated with an increased risk of hospitalization for confusion, delirium, or dementia. Health care professionals need to be alert to the contribution of CNS-acting medicines among patients presenting with confusion or delirium and consider strategies to reduce treatment burden where possible.</description><subject>Administrative Claims, Healthcare</subject><subject>Aged</subject><subject>Antipsychotic Agents - adverse effects</subject><subject>Australia</subject><subject>cognitive impairment</subject><subject>Confusion - chemically induced</subject><subject>Delirium</subject><subject>Delirium - chemically induced</subject><subject>dementia</subject><subject>Dementia - chemically induced</subject><subject>Female</subject><subject>geriatrics</subject><subject>Hospitalization - trends</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical Education</subject><subject>psychotropics</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><issn>1525-8610</issn><issn>1538-9375</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU-PFCEQxYnRuOvqJzAxHD1stwX034Mmk1l1TVZNXD0TBgpDTzfMQvcm8-2lndWDF09Q8B6P-hUhLxmUDFjzZigHNRlV8lyUwEuA7hE5Z7Xoil609eN1z-uiaxickWcpDQBZ2jdPyRlvIV81cE72W_RzVCP9gvE-LIneHtOMU7HRs_M_6Wc0TjuPiSpv6DeX9jRYeh3Swc3ZtDGTS8kFT22IdBu8Xdbqkl7h6KJbpkuaz69wyiFOPSdPrBoTvnhYL8iPD--_b6-Lm68fP203N4WuWDUXpmGi6xRWbSMQWy06W9doGCjBlbE7VZm-74UVqurbbqeFshXfMWORtbznRlyQ16d3DzHcLZhmmX-pcRyVx9yiZG3PMyXoIEvFSapjSCmilYfoJhWPkoFcKctB_qYsV8oSuMyUs-vVQ8Cym9D89fzBmgVvTwLMbd47jDJph15nmhH1LE1w_wl4949fj847rcY9HjENYYk-E5RMpmyQt-ug1zmzBoCtff0C1AakEA</recordid><startdate>20160601</startdate><enddate>20160601</enddate><creator>Kalisch Ellett, Lisa M., BPharm(Hons), PhD</creator><creator>Pratt, Nicole L., BSc(Hons), PhD</creator><creator>Ramsay, Emmae N., MClinEpid</creator><creator>Sluggett, Janet K., BPharm(Hons), GDipClinEpid, PhD</creator><creator>Barratt, John D., BPharm, BAppSci</creator><creator>Roughead, Elizabeth E., BPharm, GradDip Health Promotion, MAppSc, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160601</creationdate><title>Central Nervous System-Acting Medicines and Risk of Hospital Admission for Confusion, Delirium, or Dementia</title><author>Kalisch Ellett, Lisa M., BPharm(Hons), PhD ; Pratt, Nicole L., BSc(Hons), PhD ; Ramsay, Emmae N., MClinEpid ; Sluggett, Janet K., BPharm(Hons), GDipClinEpid, PhD ; Barratt, John D., BPharm, BAppSci ; Roughead, Elizabeth E., BPharm, GradDip Health Promotion, MAppSc, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-d61388ae4763ee7c38f55ed10a32adfba4d9993f3a4978bc3af42b1dfe17292d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Administrative Claims, Healthcare</topic><topic>Aged</topic><topic>Antipsychotic Agents - adverse effects</topic><topic>Australia</topic><topic>cognitive impairment</topic><topic>Confusion - chemically induced</topic><topic>Delirium</topic><topic>Delirium - chemically induced</topic><topic>dementia</topic><topic>Dementia - chemically induced</topic><topic>Female</topic><topic>geriatrics</topic><topic>Hospitalization - trends</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical Education</topic><topic>psychotropics</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kalisch Ellett, Lisa M., BPharm(Hons), PhD</creatorcontrib><creatorcontrib>Pratt, Nicole L., BSc(Hons), PhD</creatorcontrib><creatorcontrib>Ramsay, Emmae N., MClinEpid</creatorcontrib><creatorcontrib>Sluggett, Janet K., BPharm(Hons), GDipClinEpid, PhD</creatorcontrib><creatorcontrib>Barratt, John D., BPharm, BAppSci</creatorcontrib><creatorcontrib>Roughead, Elizabeth E., BPharm, GradDip Health Promotion, MAppSc, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Medical Directors Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kalisch Ellett, Lisa M., BPharm(Hons), PhD</au><au>Pratt, Nicole L., BSc(Hons), PhD</au><au>Ramsay, Emmae N., MClinEpid</au><au>Sluggett, Janet K., BPharm(Hons), GDipClinEpid, PhD</au><au>Barratt, John D., BPharm, BAppSci</au><au>Roughead, Elizabeth E., BPharm, GradDip Health Promotion, MAppSc, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Central Nervous System-Acting Medicines and Risk of Hospital Admission for Confusion, Delirium, or Dementia</atitle><jtitle>Journal of the American Medical Directors Association</jtitle><addtitle>J Am Med Dir Assoc</addtitle><date>2016-06-01</date><risdate>2016</risdate><volume>17</volume><issue>6</issue><spage>530</spage><epage>534</epage><pages>530-534</pages><issn>1525-8610</issn><eissn>1538-9375</eissn><abstract>Abstract Background Most studies assessing the effect of central nervous system (CNS)-acting medicines on cognitive disturbances have focused on the use of individual medicines. The impact on cognitive function when another CNS-acting medicine is added to a patient's treatment regimen is not well known. Objective To determine risk of hospitalization for confusion, delirium, or dementia in older people associated with increasing numbers of CNS-acting medicines taken concurrently, as well as the number of standard doses taken each day (measured as defined daily doses). Design Retrospective cohort study, from July 2011 to June 2012, using health claims data. Setting Australian veteran population. Participants A total of 74,321 community-dwelling individuals aged 65 years and over, who were dispensed at least 1 CNS-acting medicine in the year before study entry. Patients with prior hospitalization for confusion or delirium, and those with dementia or receiving palliative care, were excluded. Main outcome measure Hospitalization for confusion, delirium, or dementia. Results Over the 1-year study period, 401 participants were hospitalized with confusion, delirium, or dementia. Adjusted analyses showed the risk of hospitalization was 2.4 times greater with the use of 2 CNS-acting medicines compared with no use [incident rate ratio (IRR) 2.39, 95% confidence interval (CI) 1.79–3.19, P < .001], and more than 19 times greater when 5 or more CNS-acting medicines were taken concurrently (IRR 19.35, 95% CI 11.10–33.72, P < .001). Similarly, the risk of hospitalization was significantly increased among patients taking between 1.0 and 1.9 standard doses per day (IRR 2.64, 95% CI 1.99–3.50, P < .001) and between 2.0 and 2.9 standard doses per day (IRR 3.43, 95% CI 2.07–5.69, P < .001) compared with no use. Conclusions Use of multiple CNS-acting medicines or higher doses is associated with an increased risk of hospitalization for confusion, delirium, or dementia. Health care professionals need to be alert to the contribution of CNS-acting medicines among patients presenting with confusion or delirium and consider strategies to reduce treatment burden where possible.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27052560</pmid><doi>10.1016/j.jamda.2016.02.008</doi><tpages>5</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1525-8610 |
| ispartof | Journal of the American Medical Directors Association, 2016-06, Vol.17 (6), p.530-534 |
| issn | 1525-8610 1538-9375 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1792538080 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Administrative Claims, Healthcare Aged Antipsychotic Agents - adverse effects Australia cognitive impairment Confusion - chemically induced Delirium Delirium - chemically induced dementia Dementia - chemically induced Female geriatrics Hospitalization - trends Humans Internal Medicine Male Medical Education psychotropics Retrospective Studies Risk Assessment |
| title | Central Nervous System-Acting Medicines and Risk of Hospital Admission for Confusion, Delirium, or Dementia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-01T10%3A52%3A59IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Central%20Nervous%20System-Acting%20Medicines%20and%20Risk%20of%20Hospital%20Admission%20for%20Confusion,%20Delirium,%20or%20Dementia&rft.jtitle=Journal%20of%20the%20American%20Medical%20Directors%20Association&rft.au=Kalisch%20Ellett,%20Lisa%20M.,%20BPharm(Hons),%20PhD&rft.date=2016-06-01&rft.volume=17&rft.issue=6&rft.spage=530&rft.epage=534&rft.pages=530-534&rft.issn=1525-8610&rft.eissn=1538-9375&rft_id=info:doi/10.1016/j.jamda.2016.02.008&rft_dat=%3Cproquest_cross%3E1792538080%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1792538080&rft_id=info:pmid/27052560&rft_els_id=S1525861016001080&rfr_iscdi=true |