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Hospital-acquired adverse drug reactions (HA-ADRs) are common in older adults. However, there is limited knowledge regarding the association between HA-ADRs and adverse clinical outcomes. To investigate the incidence and characteristics of HA-ADRs in older adults, and any association with mortality, length of stay, and readmissions. Prospective cohort study. Flinders Medical Centre, a large tertiary referral hospital in Adelaide, South Australia. Older adults admitted under the General Medicine and Acute Care of the Elderly units with no previous diagnosis of dementia. All patients had a Multidimensional Prognostic Index (MPI) assessment performed within 3 days of the admission. Data collected included age, gender, estimated glomerular filtration rate (eGFR), length of stay, readmissions, and mortality. HA-ADRs were identified by review of individual discharge summaries. Univariate and multivariate analyses were performed to investigate associations with clinical outcomes including mortality, length of stay, and readmissions. Exploratory analyses were performed for HA-ADR groups based on Medical Dictionary for Regulatory Activities System Organ Class and World Health Organization Anatomical Therapeutic Chemical classifications that accounted for ≥10% of all HA-ADRs. There were 737 patients in the cohort with 72 having experienced a HA-ADRs (incidence = 9.8%). Patients with an HA-ADR had increased length of stay and 30-day readmissions compared with those without an HA-ADR. In multivariate analysis, the number of HA-ADRs was associated with in-hospital mortality and length of stay but not post-discharge mortality or readmissions within 30 days. In exploratory analyses, patients with an HA-ADR to antibacterial drugs had significantly higher rates of in-hospital mortality compared with those without these reactions. The number of HA-ADRs are associated with in-hospital mortality and length of stay in older Australian inpatients. The occurrence of HA-ADRs may be a trigger to offer advice to prescribers to prevent future ADRs to similar agents and proactively manage disease to improve health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to describe the prevalence of cognitive impairment in hospital inpatients, the associated need for assistance with activities of daily living (ADL) and carer perceptions of hospital care. Methods: A prospective cross-sectional observational study was conducted in a large metropolitan teaching hospital in Brisbane, Australia. Participants were inpatients aged ≥65 years and their carers. Cognitive impairment was measured by clinician auditors using the validated 4 'A's test (4AT), with a score >0 indicating cognitive impairment (1–3, probable dementia; >3, probable delirium). The need for supervision and/or assistance with ADL was recorded from daily nursing documentation. Carers were invited to complete a brief questionnaire. Results: In all, 92 of 216 older inpatients (43%) had cognitive impairment, including 52 (24%) with probable delirium. The need for supervision and/or assistance with ADL increased significantly with 4AT score. Fifty-two carers of patients with cognitive impairment reported feeling welcome and that care was safe. They identified opportunities for better information, greater support and more inclusion of carers. Conclusions: Cognitive impairment is common in older inpatients and is associated with increased care needs. Workforce planning and health professional training need to acknowledge the needs of patients with cognitive impairment. There are opportunities for greater support and more involvement of carers. What is known about the topic?: Cognitive impairment due to delirium and dementia increases with age, and is common in older medical and surgical inpatients. However, cognitive impairment remains under-recognised by healthcare staff. Australian guidelines now recommend routine screening using valid tools, and including carers, when appropriate, when assessing, caring for and communicating with people with cognitive impairment. What does this paper add?: This cross-sectional study using the validated 4AT showed 43% of hospital inpatients aged ≥65 years had cognitive impairment. Participants with cognitive impairment had higher care needs and much longer hospitalisations. Carers of people with cognitive impairment reported unmet information needs in hospital and had limited involvement in assessment and care. What are the implications for practitioners?: Cognitive impairment is common in older inpatients. Hospitals and healthcare professionals must be prepared and equipped to recognise cognitive impairment, and address the accompanying patient and carer needs. [ABSTRACT FROM AUTHOR]

Objective To explore the relationship between polypharmacy and adverse outcomes among older hospital inpatients stratified according to their frailty status. Design and setting A prospective study of 1418 patients, aged 70 and older, admitted to 11 hospitals across Australia. Measurements The interRAI Acute Care (AC) assessment tool was used for all data collection, including the derivation of a frailty index calculated using the deficit accumulation method. Polypharmacy was categorized into 3 groups based on the number of regular drugs prescribed. Recorded adverse health outcomes were falls, delirium, functional and cognitive decline, discharge to a higher level of care and in-hospital mortality. Results Patients had a mean (SD) age of 81 (6.8) years and 55% were women. Polypharmacy (5–9 drugs per day) was observed in 48.2% (n = 684) and hyper-polypharmacy (≥10 drugs) in 35.0% (n = 497). Severe cognitive impairment was significantly associated with nonpolypharmacy compared with polypharmacy and hyper-polypharmacy groups combined ( P = .004). In total, 591 (42.5%) patients experienced at least 1 adverse outcome. The only adverse outcome associated with polypharmacy was delirium. Within each polypharmacy category, frailty was associated with adverse outcomes and the lowest overall incidence was among robust patients prescribed 10 or more drugs. Conclusion While polypharmacy may be a useful signal for medication review, in this study it was not an independent predictor of adverse outcomes for older inpatients. Assessing the frailty status of patients better appraised risk. Extensive de-prescribing in all older inpatients may not be an intervention that directly improves outcomes. [ABSTRACT FROM AUTHOR]