Becky A Briesacher1, Brianne L Olivieri-Mui2, Benjamin Koethe1, Jane S Saczynski1, Donna Marie Fick3, John W Devlin1, Edward R Marcantonio4. 1. Bouvé College of Health Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts, USA. 2. Hebrew SeniorLife, The Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, USA. 3. Center of Geriatric Nursing Excellence, Penn State College of Nursing, University Park, Pennsylvania, USA. 4. Harvard Medical School, Divisions of General Medicine and Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Abstract
BACKGROUND: A positive delirium screen at skilled-nursing facility (SNF) admission can trigger a simultaneous diagnosis of Alzheimer's Disease or related dementia (AD/ADRD) and lead to psychoactive medication treatment despite a lack of evidence supporting use. METHODS: This was a nationwide historical cohort study of 849,086 Medicare enrollees from 2011-2013 who were admitted to the SNF from a hospital without a history of dementia. Delirium was determined through positive Confusion Assessment Method screen and incident AD/ADRD through active diagnosis or claims. Cox proportional hazard models predicted the risk of receiving one of three psychoactive medications (i.e., antipsychotics, benzodiazepines, antiepileptics) within 7 days of SNF admission and within the entire SNF stay. RESULTS: Of 849,086 newly-admitted SNF patients (62.6% female, mean age 78), 6.1% had delirium (of which 35.4% received an incident diagnosis of AD/ADRD); 12.6% received antipsychotics, 30.4% benzodiazepines, and 5.8% antiepileptics. Within 7 days of admission, patients with delirium and incident dementia were more likely to receive an antipsychotic (relative risk [RR] 3.09; 95% confidence interval [CI] 2.99 to 3.20), or a benzodiazepine (RR 1.23; 95% CI 1.19 to 1.27) than patients without either condition. By the end of the SNF stay, patients with both delirium and incident dementia were more likely to receive an antipsychotic (RR 3.04; 95% CI 2.95 to 3.14) and benzodiazepine (RR 1.32; 95% CI 1.29 to 1.36) than patients without either condition. CONCLUSION: In this historical cohort, a positive delirium screen was associated with a higher risk of receiving psychoactive medication within 7 days of SNF admission, particularly in patients with an incident AD/ADRD diagnosis. Future research should examine strategies to reduce inappropriate psychoactive medication prescribing in older adults admitted with delirium to SNFs.
BACKGROUND: A positive delirium screen at skilled-nursing facility (SNF) admission can trigger a simultaneous diagnosis of Alzheimer's Disease or related dementia (AD/ADRD) and lead to psychoactive medication treatment despite a lack of evidence supporting use. METHODS: This was a nationwide historical cohort study of 849,086 Medicare enrollees from 2011-2013 who were admitted to the SNF from a hospital without a history of dementia. Delirium was determined through positive Confusion Assessment Method screen and incident AD/ADRD through active diagnosis or claims. Cox proportional hazard models predicted the risk of receiving one of three psychoactive medications (i.e., antipsychotics, benzodiazepines, antiepileptics) within 7 days of SNF admission and within the entire SNF stay. RESULTS: Of 849,086 newly-admitted SNF patients (62.6% female, mean age 78), 6.1% had delirium (of which 35.4% received an incident diagnosis of AD/ADRD); 12.6% received antipsychotics, 30.4% benzodiazepines, and 5.8% antiepileptics. Within 7 days of admission, patients with delirium and incident dementia were more likely to receive an antipsychotic (relative risk [RR] 3.09; 95% confidence interval [CI] 2.99 to 3.20), or a benzodiazepine (RR 1.23; 95% CI 1.19 to 1.27) than patients without either condition. By the end of the SNF stay, patients with both delirium and incident dementia were more likely to receive an antipsychotic (RR 3.04; 95% CI 2.95 to 3.14) and benzodiazepine (RR 1.32; 95% CI 1.29 to 1.36) than patients without either condition. CONCLUSION: In this historical cohort, a positive delirium screen was associated with a higher risk of receiving psychoactive medication within 7 days of SNF admission, particularly in patients with an incident AD/ADRD diagnosis. Future research should examine strategies to reduce inappropriate psychoactive medication prescribing in older adults admitted with delirium to SNFs.
Authors: Truls Ostbye; Donald H Taylor; Elizabeth C Clipp; Lynn Van Scoyoc; Brenda L Plassman Journal: Health Serv Res Date: 2008-02 Impact factor: 3.402
Authors: Roozbeh Nikooie; Karin J Neufeld; Esther S Oh; Lisa M Wilson; Allen Zhang; Karen A Robinson; Dale M Needham Journal: Ann Intern Med Date: 2019-09-03 Impact factor: 25.391
Authors: Lauren B Gerlach; Helen C Kales; Hyungjin Myra Kim; Julie P W Bynum; Claire Chiang; Julie Strominger; Donovan T Maust Journal: J Am Med Dir Assoc Date: 2020-07-18 Impact factor: 4.669
Authors: Lisa Burry; Sangeeta Mehta; Marc M Perreault; Jay S Luxenberg; Najma Siddiqi; Brian Hutton; Dean A Fergusson; Chaim Bell; Louise Rose Journal: Cochrane Database Syst Rev Date: 2018-06-18
Authors: Nathan M Stall; Jonathan S Zipursky; Jagadish Rangrej; Aaron Jones; Andrew P Costa; Michael P Hillmer; Kevin Brown Journal: JAMA Intern Med Date: 2021-06-01 Impact factor: 21.873
Authors: Shirley H Bush; Katie L Marchington; Meera Agar; Daniel H J Davis; Lindsey Sikora; Tammy W Y Tsang Journal: BMJ Open Date: 2017-03-10 Impact factor: 2.692