Skip to main content

Drug-related hospital admissions among old people with dementia

European Journal of Clinical Pharmacology volume 72, pages 1143–1153 (2016)Cite this article

Abstract

Purpose

Drug treatment associated problems are common and are the cause of a large proportion of hospitalizations in old people. People with dementia are especially at risk of drug-related problems. The objectives of this study were to assess the occurrence and character of drug-related problems that lead to acute hospital admissions among old people (≥65 years) with dementia or cognitive impairment.

Methods

This study was conducted in orthopedic and internal medicine wards in two hospitals in Northern Sweden. Information about acute admissions was collected from the medical records. A total of 458 people aged 65 years or older with dementia or cognitive impairment were included in the study. The contribution of drug-related problems to each hospitalization was assessed.

Results

Of 458 acute hospital admissions, 189 (41.3 %) were determined to be drug-related. The most common drug-related problem (86/189; 45.5 %) was an adverse drug reaction. In total, 264 drugs were judged to be involved in 189 drug-related admissions, of which cardiovascular (29.5 %) and psychotropic (26.9 %) drugs were the most commonly involved drug classes. The relationship between the drug-related problem and the admission was judged certain in 25 cases, probable in 78 cases, and possible in 86 cases. Drug-related admissions were more common among people taking more drugs (p = 0.035) and among younger patients (p = 0.031).

Conclusion

Drug-related problems appear to be responsible for a major proportion of hospitalizations among old people with dementia or cognitive impairment. Targeted interventions such as education and medication reviews may be warranted to reduce drug-related problems.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD (1990) Drug-related problems: their structure and function. DICP 24(11):1093–1097

    CAS  PubMed  Google Scholar 

  2. Turnheim K (2004) Drug therapy in the elderly. Exp Gerontol 39(11):1731–1738

    CAS  Article  PubMed  Google Scholar 

  3. Winterstein AG, Sauer BC, Hepler CD, Poole C (2002) Preventable drug-related hospital admissions. Ann Pharmacother 36(7–8):1238–1248

    Article  PubMed  Google Scholar 

  4. Col N, Fanale JE, Kronholm P (1990) The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med 150(4):841–845

    CAS  Article  PubMed  Google Scholar 

  5. Mannesse CK, Derkx FH, de Ridder MA, Man in 't Veld AJ, van der Cammen TJ (2000) Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 29(1):35–39

    CAS  Article  PubMed  Google Scholar 

  6. Chan M, Nicklason F, Vial JH (2001) Adverse drug events as a cause of hospital admission in the elderly. Intern Med J 31(4):199–205

    CAS  Article  PubMed  Google Scholar 

  7. Salvi F, Marchetti A, D'Angelo F, Boemi M, Lattanzio F, Cherubini A (2012) Adverse drug events as a cause of hospitalization in older adults. Drug Saf 35(1):29–45

    Article  PubMed  Google Scholar 

  8. Rogers S, Wilson D, Wan S, Griffin M, Rai G, Farrell J (2009) Medication- related admissions in older people: a cross-sectional, observational study. Drugs Aging 26(11):951

    Article  PubMed  Google Scholar 

  9. Price SD, Holman CD, Sanfilippo FM, Emery JD (2014) Association between potentially inappropriate medications from the Beers criteria and the risk of unplanned hospitalization in elderly patients. Ann Pharmacother 48(1):6–16

    Article  PubMed  Google Scholar 

  10. Skoldunger A, Fastbom J, Wimo A, Fratiglioni L, Johnell K (2015) Impact of inappropriate drug use on hospitalizations, mortality, and costs in older persons and persons with dementia: findings from the SNAC study. Drugs Aging 32(8):671–678

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rodenburg EM, Stricker BHC, Visser LE (2011) Sex-related differences in hospital admissions attributed to adverse drug reactions in the Netherlands. Br J Clin Pharmacol 71(1):95

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bynum JPW, Rabins PV, Weller W, Niefeld M, Anderson GF, Wu AW (2004) The relationship between a dementia diagnosis, chronic illness, Medicare expenditures, and hospital use. J Am Geriatr Soc 52(2):187–194

    Article  PubMed  Google Scholar 

  13. Shen H-N, Lu C-L, Li C-Y (2012) Dementia increases the risks of acute organ dysfunction, severe sepsis and mortality in hospitalized older patients: a national population-based study. PLoS One 7(8):E42751

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. Lauque S, Arnaud-battandier F, Gillette S, Jm P, Andrieu S, Cantet C, Vellas B (2004) Improvement of weight and fat-free mass with oral nutritional supplementation in patients with Alzheimer’s disease at risk of malnutrition: a prospective randomized study. J Am Geriatr Soc 52(10):1702–1707

    Article  PubMed  Google Scholar 

  15. Moore A, O’Keeffe S (1999) Drug-induced cognitive impairment in the elderly. Drugs Aging 15(1):15–28

    CAS  Article  PubMed  Google Scholar 

  16. Krista LL, Nathan H, Goran E, Robert Van R, Kenton R, Claudio AN (2002) Central serotonergic activity is related to the aggressive behaviors of Alzheimer’s disease. Neuropsychopharmacology 27(4):646

    Google Scholar 

  17. Mehta D, Short J, Hilmer S, Nicolazzo J (2015) Drug access to the central nervous system in Alzheimer’s disease: preclinical and clinical insights. Pharm Res 32(3):819–839

    CAS  Article  PubMed  Google Scholar 

  18. Hayes TL, Larimer N, Adami A, Kaye JA (2009) Medication adherence in healthy elders. J Aging Health 21(4):567–580

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mjorndal T, Boman MD, Hagg S, Backstrom M, Wiholm BE, Wahlin A, Dahlqvist R (2002) Adverse drug reactions as a cause for admissions to a department of internal medicine. Pharmacoepidemiol Drug Saf 11(1):65–72

    Article  PubMed  Google Scholar 

  20. Howard RL, Avery AJ, Slavenburg S, Royal S, Pipe G, Lucassen P, Pirmohamed M (2007) Which drugs cause preventable admissions to hospital? A systematic review. Br J Clin Pharmacol 63(2):136–147

    CAS  Article  PubMed  Google Scholar 

  21. Cipolle R, Strand L, Morely P (1998) Pharmaceutical care practice. The McGraw-Hill Companies inc, New York

    Google Scholar 

  22. The National Board of Health and Welfare (2010). Indikatorer för god läkemedelsterapi hos äldre. [Eng. Indicators for evaluating the quality of older people's drug therapy]. Available from http://www.socialstyrelsen.se/publikationer2010/2010-6-29. Accessed 23 Nov 2015.

  23. Taffet G, Donohue J, Altman P (2014) Considerations for managing chronic obstructive pulmonary disease in the elderly. Clin Interv Aging:23–30

  24. Gustafsson M, Karlsson S, Lovheim H (2013) Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units. BMC Pharmacol Toxicol 14:10

    Article  PubMed  PubMed Central  Google Scholar 

  25. Gustafsson M, Karlsson S, Gustafson Y, Lovheim H (2013) Psychotropic drug use among people with dementia-a six-month follow-up study. BMC Pharmacol Toxicol 14:56

    Article  PubMed  PubMed Central  Google Scholar 

  26. Park H, Satoh H, Miki A, Urushihara H, Sawada Y (2015) Medications associated with falls in older people: systematic review of publications from a recent 5-year period. Eur J Clin Pharmacol 71(12):1429–1440

    CAS  Article  PubMed  Google Scholar 

  27. Tinetti ME, Han L, Lee DS, McAvay GJ, Peduzzi P, Gross CP, Zhou B, Lin H (2014) Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 174(4):588–595

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, Kettis-Lindblad A, Melhus H, Morlin C (2009) A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med 169(9):894–900

    Article  PubMed  Google Scholar 

  29. Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T (2015) The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995-2010. BMC Med 13:74

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This study was supported financially by grants from the Swedish Dementia Association, the County Council of Västerbotten, Janne Elgqvists foundation, the Swedish Society of Medicine and the foundation for Medical Research in Skellefteå.

Author information

Affiliations

  1. Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, Umeå, Sweden

    Maria Gustafsson, Maria Sjölander, Bettina Pfister, Jeanette Jonsson & Jörn Schneede

  2. Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden

    Maria Gustafsson & Hugo Lövheim

Authors
  1. Maria Gustafsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Sjölander
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bettina Pfister
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeanette Jonsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jörn Schneede
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hugo Lövheim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Gustafsson.

Ethics declarations

Author’s contributions

M. Gustafsson, B. Pfister, J. Jonsson, and H. Lövheim analyzed and interpreted the data and prepared the manuscript. M. Gustafsson, M. Sjölander, B. Pfister, J. Jonsson, J. Schneede, and H. Lövheim were responsible for the study concept and design. All authors carried out a critical revision of the manuscript, contributed with comments, and approved the final version.

Conflict of interest

The authors declare that they have no conflicts of interest.

Electronic supplementary material

ESM 1

(DOCX 81 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gustafsson, M., Sjölander, M., Pfister, B. et al. Drug-related hospital admissions among old people with dementia. Eur J Clin Pharmacol 72, 1143–1153 (2016). https://doi.org/10.1007/s00228-016-2084-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-016-2084-3

Keywords

  • Old people
  • Dementia
  • Drug-related problems
  • Drug-related hospitalizations