Kate N Wang1, J Simon Bell2,3,4, Esa Y H Chen2,3, Julia F M Gilmartin-Thomas4,5, Jenni Ilomäki2,4. 1. Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia. kate.wang@monash.edu. 2. Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia. 3. NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia. 4. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. 5. Research Department of Practice and Policy, University College London School of Pharmacy, London, UK.
Abstract
BACKGROUND: Residents of long-term care facilities (LTCFs) are at high risk of hospitalization. Medications are a potentially modifiable risk factor for hospitalizations. OBJECTIVE: Our objective was to systematically review the association between medications or prescribing patterns and hospitalizations from LTCFs. METHODS: We searched MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and International Pharmaceutical Abstracts (IPA) from inception to August 2017 for longitudinal studies reporting associations between medications or prescribing patterns and hospitalizations. Two independent investigators completed the study selection, data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Tools. RESULTS: Three randomized controlled trials (RCTs), 22 cohort studies, five case-control studies, one case-time-control study and one case-crossover study, investigating 13 different medication classes and two prescribing patterns were included. An RCT demonstrated that high-dose influenza vaccination reduced all-cause hospitalization compared with standard-dose vaccination (risk ratio [RR] 0.93; 95% confidence interval [CI] 0.88-0.98). Another RCT found no difference in hospitalization rates between oseltamivir as influenza treatment and oseltamivir as treatment plus prophylaxis (treatment = 4.7%, treatment and prophylaxis = 3.5%; p = 0.7). The third RCT found no difference between multivitamin/mineral supplementation and hospitalization (odds ratio [OR] 0.94; 95% CI 0.74-1.20) or emergency department visits (OR 1.05; 95% CI 0.76-1.47). Two cohort studies demonstrated influenza vaccination reduced hospitalization. Four studies suggested polypharmacy and potentially inappropriate medications (PIMs) increased all-cause hospitalization. However, associations between polypharmacy (two studies), PIMs (one study) and fall-related hospitalizations were inconsistent. Inconsistent associations were found between psychotropic medications with all-cause and cause-specific hospitalizations (11 studies). Warfarin, nonsteroidal anti-inflammatory drugs, pantoprazole and vinpocetine but not long-term acetylsalicylic acid (aspirin), statins, trimetazidine, digoxin or β-blockers were associated with all-cause or cause-specific hospitalizations in single studies of specific resident populations. Most cohort studies assessed prevalent rather than incident medication exposure, and no studies considered time-varying medication use. CONCLUSION: High-quality evidence suggests influenza vaccination reduces hospitalization. Polypharmacy and PIMs are consistently associated with increased all-cause hospitalization.
BACKGROUND: Residents of long-term care facilities (LTCFs) are at high risk of hospitalization. Medications are a potentially modifiable risk factor for hospitalizations. OBJECTIVE: Our objective was to systematically review the association between medications or prescribing patterns and hospitalizations from LTCFs. METHODS: We searched MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and International Pharmaceutical Abstracts (IPA) from inception to August 2017 for longitudinal studies reporting associations between medications or prescribing patterns and hospitalizations. Two independent investigators completed the study selection, data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Tools. RESULTS: Three randomized controlled trials (RCTs), 22 cohort studies, five case-control studies, one case-time-control study and one case-crossover study, investigating 13 different medication classes and two prescribing patterns were included. An RCT demonstrated that high-dose influenza vaccination reduced all-cause hospitalization compared with standard-dose vaccination (risk ratio [RR] 0.93; 95% confidence interval [CI] 0.88-0.98). Another RCT found no difference in hospitalization rates between oseltamivir as influenza treatment and oseltamivir as treatment plus prophylaxis (treatment = 4.7%, treatment and prophylaxis = 3.5%; p = 0.7). The third RCT found no difference between multivitamin/mineral supplementation and hospitalization (odds ratio [OR] 0.94; 95% CI 0.74-1.20) or emergency department visits (OR 1.05; 95% CI 0.76-1.47). Two cohort studies demonstrated influenza vaccination reduced hospitalization. Four studies suggested polypharmacy and potentially inappropriate medications (PIMs) increased all-cause hospitalization. However, associations between polypharmacy (two studies), PIMs (one study) and fall-related hospitalizations were inconsistent. Inconsistent associations were found between psychotropic medications with all-cause and cause-specific hospitalizations (11 studies). Warfarin, nonsteroidal anti-inflammatory drugs, pantoprazole and vinpocetine but not long-term acetylsalicylic acid (aspirin), statins, trimetazidine, digoxin or β-blockers were associated with all-cause or cause-specific hospitalizations in single studies of specific resident populations. Most cohort studies assessed prevalent rather than incident medication exposure, and no studies considered time-varying medication use. CONCLUSION: High-quality evidence suggests influenza vaccination reduces hospitalization. Polypharmacy and PIMs are consistently associated with increased all-cause hospitalization.
Authors: Rosa Liperoti; Giovanni Gambassi; Kate L Lapane; Claire Chiang; Claudio Pedone; Vincent Mor; Roberto Bernabei Journal: Arch Intern Med Date: 2005-03-28
Authors: Taliesin E Ryan-Atwood; Mieke Hutchinson-Kern; Jenni Ilomäki; Michael J Dooley; Susan G Poole; Carl M Kirkpatrick; Elizabeth Manias; Biswadev Mitra; J Simon Bell Journal: Drugs Aging Date: 2017-08 Impact factor: 3.923
Authors: F Lattanzio; C Mussi; E Scafato; C Ruggiero; G Dell'Aquila; C Pedone; F Mammarella; L Galluzzo; G Salvioli; U Senin; P U Carbonin; R Bernabei; A Cherubini Journal: J Nutr Health Aging Date: 2010-03 Impact factor: 4.075
Authors: Robert Booy; Richard I Lindley; Dominic E Dwyer; Jiehui K Yin; Leon G Heron; Cameron R M Moffatt; Clayton K Chiu; Alexander E Rosewell; Anna S Dean; Timothy Dobbins; David J Philp; Zhanhai Gao; C Raina MacIntyre Journal: PLoS One Date: 2012-10-17 Impact factor: 3.240
Authors: Kate N Wang; J Simon Bell; Edwin C K Tan; Julia F M Gilmartin-Thomas; Michael J Dooley; Jenni Ilomäki Journal: Drugs Aging Date: 2019-11 Impact factor: 3.923
Authors: M Alcusky; R B Thomas; N Jafari; S W Keith; A Kee; S Del Canale; M Lombardi; V Maio Journal: BMC Geriatr Date: 2021-03-31 Impact factor: 3.921
Authors: Janet K Sluggett; Samanta Lalic; Sarah M Hosking; Brett Ritchie; Jennifer McLoughlin; Terry Shortt; Leonie Robson; Tina Cooper; Kelly A Cairns; Jenni Ilomäki; Renuka Visvanathan; J Simon Bell Journal: Int J Environ Res Public Health Date: 2020-05-08 Impact factor: 3.390