Search

Introduction The prescription of psychotropic drugs to older patients in a hospital setting has not been extensively characterized. The objective was to describe the inappropriate co-prescriptions of psychotropic drugs in hospitalized patients aged 75 and over. Methods By analysing the medical database from 222-bed general hospital in France, we reviewed a total of 11,929 stays of at least 3 days by patients aged 75 and over. Prescriptions and co-prescriptions of psychotropic drugs were identified automatically. Anticholinergic drugs with sedative effects were considered as psychotropic drugs. An expert review was performed for stays with the co-prescription of three or more psychotropic drugs to identify inappropriate co-prescriptions. Results Administration of a psychotropic drug was identified in 5475 stays (45.9% of the total number of stays), of which 1526 (12.8% of the total) featured at least one co-prescription. Co-prescriptions of three or more psychotropic drugs for at least 3 days were identified in 374 stays (3.1% of the total). Most of these co-prescriptions ( n =334; 89.2%) were considered inappropriate because of the combination of at least two drugs from the same psychotropic class ( n =269), the absence of a clear indication for a psychotropic drug ( n =173) and a history of falls ( n =86). However, the co-prescriptions were maintained after hospital discharge in 77.4% of cases. Conclusion The co-prescriptions of psychotropic drugs should be re-evaluated in older hospitalized patients.

Background The consequences of an incident delirium (ID) are multiple and severe among the hospitalized elderly patients. Many medications are recognized risk factors for delirium. The aim of this study was to determine the incidence of ID in an acute geriatric unit and to assess the role of iatrogenic factors among the precipitating factors of ID. Methods The study included 369 consecutive incident patients who were admitted in our Acute Geriatric Unit between January and April 2013. Delirium was diagnosed with the Confusion Assessment Method on a daily basis. The Naranjo criteria were used to determine iatrogenic causes of the ID. Results During the study, 34 (9.2%) patients exhibited 35 ID. A multifactorial origin was found in 26 (75%) of these ID. A therapeutic change likely to promote an ID was found for 11 of these ID. According to the criteria of Naranjo, seven (20%) of these ID were likely to have iatrogenic origins. Only one of these seven ID was caused exclusively by iatrogenic factors. Medication was less frequently implicated as a precipitating factor of ID than metabolic factors ( n =33; 94.4%), sources of discomfort ( n =29; 82.8%), or acute medical problems ( n =30; 85.7%). Conclusion The incidence of ID was about 10% in our acute geriatric unit. Iatrogenic factors were implicated in only one out of five ID and they were not among the three most common precipitating factors of ID.

Drug-induced hyperkalemia is a frequent and severe complication in the hospital setting. Other risk factors may also induce hyperkalemia but the combination of drugs and precipitating factors has not been extensively studied. The aim was to identify drug-induced hyperkalemia events in hospitalized older patients and to describe their combinations with precipitating factors. Two experts independently analyzed retrospective data of patients aged 75 years or more. Experts identified 471 hyperkalemia events and concluded that 379 (80.5%) were induced by drugs. The cause was multifactorial (i.e., at least one drug with a precipitating factor) in 300 (79.2%) of the 379 drug-induced hyperkalemia. Most of the drug-induced hyperkalemia events were avoidable (79.9%)-mainly because of the multifactorial cause (e.g., dosage adaptation during acute kidney injury). Drug-induced hyperkalemia events are frequently combined with precipitating factors in hospitalized older patients and their prevention should focus on these combinations.