Adverse clinical outcomes associated with drug-related hospitalizations in people with dementia

ABSTRACT

Background

This study aimed to determine the clinical impact associated with adverse drug reactions (ADRs) in patients with dementia.

Research design and methods

This case-control, propensity score-matched study utilized administrative data of people with dementia admitted to major public hospitals in Tasmania, Australia, from July 2010 to December 2019.

Results

Acute renal failure constituted the most common ADR. The length of hospital stay was greater for people with an ADR index admission, versus non-ADR index admission (median [IQR]: 9 [4–18] versus 6 [2–12]; p < 0.001). In-hospital mortality and combined in-hospital and post-hospital mortality within 30, 60 and 90 days were higher for those whose index admission was ADR-related (in-hospital: HR 1.40, 95% CI 1.11–1.77, p-value <0.001; 30 days: HR 1.25, 95% CI 1.05–1.49, p-value <0.001; 60 days: HR 1.27, 95% CI 1.08–1.49, p-value <0.001; 90 days: HR 1.29, 95% CI 1.10–1.50, p-value <0.001). Subsequent ADR admission within 30, 60 and 90 days of index discharge was 9 to 10 times greater for people with dementia (30 days: OR 10.0, 95% CI 6.04–16.8, p-value <0.001; 60 days: OR 8.96, 95% CI 5.57–14.4, p-value <0.001; 90 days: OR 9.31, 95% CI 5.79–14.9, p-value <0.001).

Conclusion

Safe prescribing and vigilant monitoring of ADRs is pivotal to mitigate adverse outcomes in people with dementia.

KEYWORDS:

• Outcomes
• adverse drug reactions
• ADR
• dementia
• hospital admission
• re-admission
• mortality

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics statement

The study was conducted with approval from the Tasmanian Department of Health Research Governance Unit and the Tasmanian Health and Medical Human Research Ethics Committee (reference number H0018582), Australia. Permission has been obtained from dataset owner (Tasmanian Health Service) to use the information in their database for the purposes of the research conducted.

Data availability statement

The data utilized in this analysis was sourced from a third party, namely the Tasmanian Department of Health and Human Services. It’s important to note that this data is not publicly accessible in Australia, and the research team has not been granted permission to make it publicly available. To access this data, necessary ethics approvals must be obtained. Upon securing these approvals, the research team will be able to request access to the data in writing by contacting: The Secretary, Department of Health, GPO Box 125, Hobart, Tasmania, 7001, Australia.

Author contributions

All authors substantially contributed to the conception and design, data acquisition, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work. All authors helped to draft the article, and all authors have read and approved the final article.

Acknowledgments

ASZ gratefully acknowledges the material and financial support of the University of Tasmania in the form of a Tasmania Graduate Research Scholarship. The authors would like to thank the Tasmanian Health Service (THS) for their ongoing support of this study.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17512433.2023.2294007

Additional information

Funding

This paper was not funded.