Increased drug burden and potentially inappropriate medication use associates with hospitalisations in older people living in residential care

Aims: To determine if anticholinergic and sedative medications measured using the Drug Burden Index (DBI) or potentially inappropriate medications (PIMs) associates with hospitalisations in people living in residential aged care facilities.

Methods: The cross-sectional Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study included 541 long-term residents from 17 facilities with a high prevalence of cognitive impairment. Pharmacy records in the 100 days prior to facility start date were used to determine the DBI (measuring anticholinergic and sedative medications exposure) and PIM use (according to the 2015 Beers Criteria for older people) for the participants. Multi-level linear models were used to examine associations between medication use and hospitalisations.
Results: In the INSPIRED study, 83% of the participants received one or more DBI medications and 73% received at least one PIM. A higher DBI was associated with a higher number of hospital admissions (b=0.295 (0.089), p < 0.001), number of emergency presentations including those leading to an admission (b=0.126 (0.049), p = 0.010) and emergency presentations excluding those leading to an admission (b=0.074 (0.033), p = 0.024) after adjustment for potential confounding factors. Increasing numbers of PIMs were associated with a higher number of hospital admissions (b=0.094 (0.039), p = 0.016).

Conclusions: Anticholinergic and sedative medications and PIMs are highly prevalent amongst individuals with cognitive impairment living in residential care. These medications are associated with adverse health outcomes including an increased risk of hospitalisation and the benefits and harms of these medications should be considered in this population.