Abstract
Objective
To investigated the effects of antipsychotics on rehabilitation outcomes for geriatric hip fracture inpatients.
Design
Retrospective cohort study.
Setting
The registry data from the Japan Rehabilitation Nutrition Database for analysis.
Participants
Of the 234 patients in the Japan Rehabilitation Nutrition Database admitted between November 2015 and March 2018, 214 met the eligibility criteria.
Measurements
The antipsychotics were phenothiazine, butyrophenone, benzamide, and atypical antipsychotics. For hip fracture patients, the following information was registered: (a) admission data: age, sex, Charlson Comorbidity Index, Functional Independence Measure (FIM) at admission, medications, height, body weight, and Mini Nutritional Assessment-Short Form score (MNA-SF) and (b) discharge data: discharge destination, FIM at discharge, MNASF, and total units of provided rehabilitation therapy (one unit = 20 minutes based on the national healthcare insurance policy).
Results
Thirteen patients (6.1%) were prescribed antipsychotics. According to the multiple linear regression analysis, antipsychotics negatively affected FIM efficiency (β=-0.190, 95% confidence interval, -0.652 to -0.104, p=0.007). Furthermore, on logistic regression analysis, fall during hospitalization was correlated with the use of antipsychotics (odds ratio=4.376, 95% confidence interval: 1.153 to 16.612, p=0.030).
Conclusion
The use of antipsychotics impaired the improvement of the activities of daily living (ADL) and increased the incidence of fall during hospitalization. Reviewing medication therapies at admission may further improve ADL.
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References
Dyer, SM, Crotty, M, Fairhall, N, Magaziner, J, Beaupre, LA, Cameron, ID, Sherrington C5. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 2016;16:158. doi: 10.1186/s12877-016-0332-02
Hagino, H, Endo, N, Harada, A, Iwamoto, J, Mashiba, T, Mori, S, Ohtori, S, Sakai, A, Takada, J, Yamamoto, T. Survey of hip fractures in Japan: Recent trends in prevalence and treatment. J Orthop Sci 2017;22:909–914. doi: 10.1016/j.jos.2017.06.003
Maher, RL, Hanlon, J, Hajjar, ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 2014;13:57–65. doi: 10.1517/14740338.2013.827660
Härstedt, M, Rogmark, C, Sutton, R, Melander, O, Fedorowski, A. Polypharmacy and adverse outcomes after hip fracture surgery. J Orthop Surg Res 2016;11:1–7. doi: 10.1186/s13018-016-0486-7
Kojima, T, Akishita, M, Nakamura, T, Nomura, K, Ogawa, S, Iijima, K, Eto, M, Ouchi, Y. Polypharmacy as a risk for fall occurrence in geriatric outpatients. Geriatr Gerontol Int 2012;12:425–430. doi: 10.1111/j.1447-0594.2011.00783.x
Lai, SW, Liao, KF, Liao, CC, Muo, CH, Liu, CS, Sung, FC. Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine(Baltimore) 2010;89:295–299. doi: 10.1097/MD.0b013e3181f15efc
Mangoni, AA, Jackson, SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004;57:6–14. doi: 10.1046/j.1365-2125.2003.02007.x
Kojima, T, Akishita, M, Kameyama, Y, Yamaguchi, K, Yamamoto, H, Eto, M, Ouchi, Y. High risk of adverse drug reactions in elderly patients taking six or more drugs: Analysis of inpatient database. Geriatr Gerontol Int 2012;12:761–762. doi: 10.1111/j.1447-0594.2012.00868.x
Wakabayashi, H. Rehabilitation pharmacotherapy: A combination of rehabilitation and pharmacotherapy. J Gen Fam Med 2018;19:43–44. doi: 10.1002/jgf2.163
Momosaki, R, Maeda, K, Wakabayashi, H. Causal inference from an observational study of geriatric rehabilitation pharmacotherapy. Geriatr Gerontol Int 2018;18:1307–1308. doi: 10.1111/ggi.13470
Kose, E, Hirai, T, Seki, T, Hayashi, H. Role of potentially inappropriate medication use in rehabilitation outcomes for geriatric patients after strokes. Geriatr Gerontol Int 2018;18:321–328. doi: 10.1111/ggi.13187
Nagano, A, Nishioka, S, Wakabayashi, H. Rehabilitation nutrition for iatrogenic sarcopenia and sarcopenic dysphagia. J Nutr Health Aging, 2018. doi: https://doi. org/10.1007/s12603-018-1150-1
Iaboni, A, Rawson, K, Burkett, C, Lenze, E, Flint, AJ. Potentially Inappropriate Medications and the Time to Full Functional Recovery After Hip Fracture. Drugs Aging 2017;34:723–728. doi: 10.1007/s40266-017-0482-6
Hershkovitz, A, Angel, C, Brill, S, Nissan, R. The Association between Anticholinergic Drug Use and Rehabilitation Outcome in Post-Acute Hip Fractured Patients: A Retrospective Cohort Study. Drugs Aging 2018;35:333–341. doi: 10.1007/s40266-018-0533-7
Kose, E, Maruyama, R, Okazoe, S, Hayashi, H. Impact of polypharmacy on the rehabilitation outcome of Japanese stroke patients in the convalescent rehabilitation ward. J Aging Res 2016. doi: 10.1155/2016/7957825
Kose, E, Hirai, T, Seki, T. Anticholinergic drugs use and risk of hip fracture in geriatric patients. Geriatr Gerontol Int 2018;18:1340–1344. doi: 10.1111/ggi.13486.
Kose, E, Hirai, T, Seki, T. Psychotropic drug use and cognitive rehabilitation practice for elderly patients. Int J Clin Pharm 2018. doi: 10.1007/s11096-018-0718-5.
Takasaki, M, Momosaki, R, Wakabayashi, H, Nishioka, S. Construction and Quality Evaluation of the Japanese Rehabilitation Nutrition Database. J Nutr Sci Vitaminol (Tokyo) 2018;64:251–257. doi: 10.3177/jnsv.64.251
Wakabayashi, H, Sakuma, K. Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management. J Cachexia Sarcopenia Muscle 2014;5:269–277. doi: 10.1007/s13539-014-0162-x
Danciu, I, Cowan, JD, Basford, M, Wang, X, Saip, A, Osgood, S, Shirey-Rice, J, Kirby, J, Harris, PA. Secondary use of clinical data: The Vanderbilt approach. J Biomed Inform 2014;52:28–35. doi: 10.1016/j.jbi.2014.02.003
Ottenbacher, KJ, Hsu, Y, Granger C, V, Fiedler, RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil 1996;77:1226–1232.
Herzig, SJ, Rothberg, MB, Guess, JR, Stevens, JP, Marshall, J, Gurwitz, JH, Marcantonio, ER. Antipsychotic use in hospitalized adults: rates, indications, and predictors. J Am Geriatr Soc 2016;64:299–305. doi: 10.1111/jgs.13943
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.
Rubenstein, LZ, Harker, JO, Salvà, A, Guigoz, Y, Vellas, B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini-Nutritional Assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001;56:366–372.
Kojima, T, Mizukami, K, Tomita, N, Arai, H, Ohrui, T, Eto, M, Takeya, Y, Isaka, Y, Rakugi, H, Sudo, N, Arai, H, Aoki, H, Horie, S, Ishii, S, Iwasaki, K, Takayama, S, Suzuki, Y, Matsui, T, Mizokami, F, Furuta, K, Toba, K, Akishita, M. Screening Tool for Older Persons’ Appropriate Prescriptions in Japanese: Report of the Japan Geriatrics Society Working Group on “Guidelines for medical treatment and its safety in the elderly.” Geriatr Gerontol Int 2016;16:983–1001. doi: 10.1111/ggi.12890
Lee, SJ, Newman, TB, Avorn, J, Fischer, MA, Mogun, H, Solomon, DH, Brookhart, MA. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med 2005;353:2335–2341. doi: 10.1056/NEJMoa052827
Takeuchi, H, Suzuki, T, Remington, G, Uchida, H. Antipsychotic Polypharmacy and Corrected QT Interval: A Systematic Review. Can J Psychiatry 2015;60:215–222. doi: 10.1177/070674371506000503
Mauri, MC, Volonteri, LS, Colasanti, A, Fiorentini, A, De Gaspari, IF, Bareggi, SR. Clinical pharmacokinetics of atypical antipsychotics: a critical review of the relationship between plasma concentrations and clinical response. Clin Pharmacokinet 2007;46:359–388. doi: 10.2165/00003088-200746050-00001
Lövheim, H, Sandman, PO, Kallin, K, Karlsson, S, Gustafson, Y. Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care. Int Psychogeriatrics 2006;18:713–726. doi: 10.1017/S1041610206003930
Leipzig, RM, Cumming, RG, Tinetti, ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999;47:40–50.
Fraser, LA, Liu, K, Naylor, KL, Hwang, YJ, Dixon, SN, Shariff, SZ, Garg, AX. Falls and fractures with atypical antipsychotic medication use: a population-based cohort study. JAMA intern med 2015;175:450–452. doi: 10.1001/jamainternmed.2014.6930
Kadra, G, Stewart, R, Shetty, H, Downs, J, MacCabe, JH, Taylor, D, Hayes, RD. Predictors of long-term (=6 months) antipsychotic polypharmacy prescribing in secondary mental healthcare. Schizophr Res 2016;174:106–112. doi: 10.1016/j. schres.2016.04.010
Geller AI, Nopkhun W, Dows-Martinez MN, Strasser DC. Polypharmacy and the Role of Physical Medicine and Rehabilitation. PM R 2012;4:198–219. doi: 10.1016/j.pmrj.2012.02.012
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Nakamichi, M., Wakabayashi, H., Nishioka, S. et al. Influence of Antipsychotics on Functional Prognosis After Geriatric Hip Fracture. J Nutr Health Aging 23, 381–385 (2019). https://doi.org/10.1007/s12603-019-1173-2
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DOI: https://doi.org/10.1007/s12603-019-1173-2