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

Abstract

Limited data are available on characteristics associated with antipsychotic use in multimorbid older adults. 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. This was asecondaryanalysis of the OPERAM randomized controlled trial. Multivariate analysis assessed the association between characteristics and comorbidities with antipsychotic use. An expert team assessed DRAoccurring during the one-year follow-up. 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. Antipsychoticprescribingat any time was not associated with DRA (OR = 1.0[0.3;3.9]) however contributed to 8 DRAs, including 3falls. In this European multimorbidpolymedicatedolder 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.