Impact of hospitalizations on problematic medication use among community dwelling persons with dementia.

BACKGROUND: Hospitalizations are frequently disruptive for persons with dementia (PWD) in part due to the use of potentially problematic medications for complications such as delirium, pain, and insomnia. We sought to determine the impact of hospitalizations on problematic medication prescribing in the months following hospitalization.

METHODS: We included community-dwelling PWD in the Health and Retirement Study aged ≥66 with a hospitalization from 2008-2018. We characterized problematic medications as medications that negatively affect cognition (strongly anticholinergics/sedative-hypnotics), medications from 2019 Beers criteria, and medications from STOPP-V2. To capture durable changes, we compared problematic medications 4 weeks pre-hospitalization (baseline) to 4 months post-hospitalization period. We used a generalized linear mixed model with Poisson distribution adjusting for age, sex, comorbidity count, pre-hospital chronic medications, and timepoint.

RESULTS: Among 1,475 PWD, 504 had a qualifying hospitalization (median age 84 (IQR=79-90), 66% female, 17% Black). There was a small increase in problematic medications from the baseline to post-hospitalization timepoint that did not reach statistical significance (adjusted mean 1.28 vs. 1.40, difference 0.12 (95% CI -0.03, 0.26), p=0.12). Results were consistent across medication domains and certain subgroups. In one pre-specified subgroup, individuals on <5 pre-hospital chronic medications showed a greater increase in post-hospital problematic medications compared to those on ≥5 medications (p=0.04 for interaction, mean increase from baseline to post-hospitalization of 0.25 for those with <5 medications (95% CI 0.05, 0.44) vs. 0.06 (95% CI -0.12, 0.25) for those with ≥5 medications).

CONCLUSIONS: Hospitalizations had a small, non-statistically significant effect on longer-term problematic medication use among PWD.