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background: Cholinesterase (ChE) inhibitors enhance central cholinergic function and are considered as standard treatments to ameliorate symptoms relating to Alzheimer's disease. Though anticholinergic medications directly antagonize the effects of ChE inhibitors, they are commonly prescribed among hospitalized adults. objective: To determine the impact of high anticholinergic burden (ACB) on length of stay (LOS) and 30-day readmission rates among hospitalized patients receiving concomitant ChE inhibitors. methods: This was a retrospective cohort study conducted at a tertiary care academic medical center involving hospitalized patients on medical floors who received any Food and Drug Administration-approved ChE inhibitors during their hospital stay from October 1, 2022, to September 30, 2023. The primary outcome of the study was to compare hospital LOS among patients with high (ACB≥ 3) versus low (ACB < 3) ACB. The secondary outcome was to assess the impact of ACB burden on 30-day readmission rates. results: Among hospitalized adults, patients with high ACB exposure had a significantly longer hospital LOS (median: 5.50 vs 4.25 days; P < 0.001) than patients with low ACB exposure, after adjusting for covariates. Analysis of secondary outcome revealed that though the high ACB group had a higher 30-day readmission rate compared with the lower ACB group (6.8% vs. 2.2%), the difference was not statistically significant (OR = 3.46, 95% CI 0.85-14.08; P = 0.083). conclusion: A high ACB exposure among older individuals taking concurrent ChE inhibitors is associated with a longer hospital stay. [ABSTRACT FROM AUTHOR]

Presenters Christopher Morley, PhD, MA, Martha Wojtowycz, PhD, Laura Schad, MPH, Kimberly Townsend, CPA, EdD, JD, MBA, MPA, Sarah McNamara, MS, Sharon Brangman, MD, john noviasky, PharmD, BCPS, Kelly Ulen, [...], Context: Polypharmacy, referring to multiple medications or the use of more drugs than are medically necessary, may lead to undesirable consequences, increasing the risk of adverse drug effects and leading to increases in falls and hospitalizations among older persons. Our objective was to retrospectively determine whether a pragmatic deprescribing protocol reduced 8 common classes of medications in two skilled nursing facilities (SNFs) in a single system. Objective: To determine whether a deprescribing effort reduced several key classes of medications, and the overall number of medication classes per patient, among long-term residents of SNFs. Study Design and Analysis: Retrospective, longitudinal pre/post evaluation. Data from before and during the implementation of the deprescribing effort (2018-2019) were compared with post-intervention years (2020-2021). Setting and Populations Studied: Long-term resident data reported through annual comprehensive minimum data set (MDS) reviews conducted at two SNFs located in central New York State between 2018 and 2021 (N=11,862). Intervention/Instrument: Multi-faceted, pragmatic interdisciplinary deprescribing effort to reduce medications in SNF residence including clinician education, guideline development, and individual chart reviews began in 2019. Outcome Measures: Overall percentage of patients on each of eight classes of medications, compare between pre- and post-intervention periods via cross-tabulation with chi- square. Mean total medication classes for each patient compared pre/post via one-way Analysis of Variance (ANOVA). Results: Mean number of medications were lower, post-intervention, at both facilities (mean=1.88 pre vs. 1.85 post, NS). Significant drops were observed in 4 of 8 categories, including Diuretics (-3.7%, p=.001), Opioids (-4.9%, p=.001), Antipsychotics (-2.0%, p=.002), Antibiotics (-1.6%, p=.045). Antianxiety medications were non-significantly reduced by 0.5%. Antidepressant usage increased (4.6%, p Conclusions: A combined, comprehensive approach to deprescribing was associated with a reduction in overall number of medication classes per resident and in several key classes of medications. Antidepressant usage likely increased as a safer offset to reductions in higher risk medications.

BACKGROUND: In older inpatients, anticholinergic medications can increase the risk of complications that may increase length of stay (LOS). Cyclobenzaprine is an anticholinergic medication associated with mental status changes, falls, and injuries in older patients. OBJECTIVE: The purpose of this study is to determine whether use of a lower cyclobenzaprine dose (5 mg) compared with higher dosing (10 mg) will affect LOS, 30-day readmission rates, and need for injectable psychotropic agents in inpatients 65 years of age and older. METHODS: This was a retrospective cohort analysis comparing outcomes in patients 65 years of age and older who received either a 5 mg or 10 mg cyclobenzaprine dose during their inpatient admission over a 2.5-year period. The primary outcome was hospital LOS, adjusted using multivariate linear regression. Secondary outcomes included 30-day readmission rate adjusted using logistic regression and use of injectable antipsychotics or benzodiazepines. A sub-analysis evaluated the impact of the institution’s implementation of a geriatric prescribing context (GEM-CON) on cyclobenzaprine dose selection. RESULTS: The adjusted LOS was 32.7% longer (95% CI 25.9%-39.9%) for patients exposed to higher-dose cyclobenzaprine. Use of injectable antipsychotics or benzodiazepines was also significantly greater in the higher-dose group (P < 0.001; P = 0.025). Cyclobenzaprine dose was not significantly associated with readmission on multivariate analysis (OR = 0.93, 95% CI 0.45-1.93). After GEM-CON implementation, there was a significant increase in use of the recommended lower cyclobenzaprine dose (P < 0.001). CONCLUSION: Use of lower cyclobenzaprine dosing in older inpatients is associated with reduced hospital LOS and need for injectable antipsychotics and benzodiazepines. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a debilitating condition that affects 1.8% of people 65 years of age and older. Patients with PD often require hospitalization and are frequently admitted through the emergency department (ED). Notably, their hospital durations tend to be lengthier compared with patients without PD. The primary outcome of this research was to compare the length of stay (LOS) of patients who received carbidopa-levodopa (CL) in the ED with those who did not. Secondary outcomes included 30-day-readmission rates and administration of injectable for agitation. In addition, the percentage of patients receiving CL before and after an information management technology (IMT) alert implementation was compared in a sub-analysis. Patients that received CL during their inpatient stay were identified by a database report in this retrospective study. Patients were excluded if they were not admitted through the ED, younger than 65 years of age, or admitted to the intensive care unit after the ED. There was a total of 266 in the control group and 217 patients in the intervention group. The intervention group had a significantly shorter LOS than the control group (3.29 vs 5.37 days; P = 0.002), significantly less frequent 30-day readmissions (P = 0.032), and used fewer injectables for agitation (P = 0.035). The sub-analysis of the IMT alert revealed that prior to the alert's implementation, 28.5% of patients received CL in the ED; whereas post-alert, this percentage increased to 91.4% (P < 0.001). The results of this study found that the group of PD patients who received CL in the ED had shorter LOS, lower 30-day readmissions, and used less injectables for agitation compared with the group that did not receive CL in the ED. This improvement is possibly due to continuity of CL supply considering its short half-life and clinical importance for PD. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine if a pharmacist driven Geriatric Medication Safety Initiative (GEMSI) procedure decreased the utilization of opioids during the residents stay in the Transitional Care Unit (TCU). METHODS: This single-center, retrospective, cohort chart review study will be conducted at a Community Hospital TCU. The study has been approved by our Institutional Review Board (Review# 2176891-1). Residents will be included if admitted to TCU in either 2016 or 2018. Residents will be excluded if it was necessary to transfer off TCU during their TCU stay. The primary endpoint will be to examine Milligram Morphine Equivalent (MME) pre- and post-implementation of GEMSI. The secondary endpoints will include milligrams and doses of acetaminophen utilized, numbers of lidocaine patches utilized, and resident reports of pain management. Statistical analysis will be performed using SPSS IBM Version 29. Categorical data will be presented in count and percentages, while continuous data will be presented in mean and interquartile range. To identify any differences between the pre and post GEMSI groups, Chi-square and Mann Whitney U test analysis will be utilized for categorical and continuous variables, respectively. CONCLUSION: The results will describe the change in opioid utilization (if any) and other variables mentioned after implementation of GEMSI procedure during the residents TCU stay. [ABSTRACT FROM AUTHOR]

The article informs about responds to Dr. Eva Stachler's positive letter and emphasizes the importance of both prescribing appropriate medications and deprescribing inappropriate ones. Topic include It cites examples of pharmacist-driven deprescribing programs and initiatives, highlighting their effectiveness in reducing the use of targeted inappropriate medications. It encourage pharmacists to advocate for older patient populations and expand their roles in improving care for this demographic.