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 to 2018. We characterized problematic medications as medications that negatively affect cognition (strongly anticholinergics/sedative-hypnotics), medications from the 2019 Beers criteria, and medications from STOPP-V2. To capture durable changes, we compared problematic medications 4 weeks prehospitalization (baseline) to 4 months posthospitalization period. We used a generalized linear mixed model with Poisson distribution adjusting for age, sex, comorbidity count, prehospital 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 posthospitalization timepoint that did not reach statistical significance (adjusted mean 1.28 vs 1.40, difference 0.12 (95% CI −0.03, 0.26), p = .12). Results were consistent across medication domains and certain subgroups. In one prespecified subgroup, individuals on <5 prehospital chronic medications showed a greater increase in posthospital problematic medications compared with those on ≥5 medications (p = .04 for interaction, mean increase from baseline to posthospitalization 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, nonstatistically significant effect on longer-term problematic medication use among PWD.

中文翻译：

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住院治疗对社区痴呆症患者问题药物使用的影响


背景 住院治疗对痴呆症患者 （PWD） 来说经常具有破坏性，部分原因是使用可能有问题的药物治疗谵妄、疼痛和失眠等并发症。我们试图确定住院治疗对住院后几个月内有问题的药物处方的影响。方法 我们将 2008 年至 2018 年住院年龄≥ 66 岁的社区居住 PWD 纳入健康与退休研究。我们将有问题的药物描述为对认知产生负面影响的药物（强烈抗胆碱能药/镇静催眠药）、2019 年 Beers 标准的药物以及 STOPP-V2 中的药物。为了捕捉持久的变化，我们比较了住院前 4 周 （基线） 和出院后 4 个月的问题药物。我们使用了广义线性混合模型，泊松分布调整了年龄、性别、合并症计数、院前慢性药物和时间点。结果 在 1 475 名 PWD 中，504 名合格住院治疗 （中位年龄 84 （IQR = 79-90），66% 女性，17% 黑人）。从基线到住院后时间点，有问题的药物略有增加，但未达到统计学意义（调整平均值 1.28 vs 1.40，差异 0.12 （95% CI -0.03,0.26），p = .12）。结果在药物领域和某些亚组之间是一致的。在一个预先指定的亚组中，与接受 ≥5 种药物的个体相比，服用 <5 院前慢性药物的个体显示出院后有问题药物的增加更大（相互作用 p = .04，使用 <5 药物的患者从基线到住院后的平均增加 0.25 （95% CI 0.05， 0.44） vs. 接受 ≥5 种药物的患者为 0.06 （95% CI -0.12， 0.25）。 结论 住院对 PWD 的长期问题药物使用有很小的、无统计学意义的影响。