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Psychoactive Medications and Adverse Outcomes among Older Adults Receiving Hemodialysis.
J Am Geriatr Soc. 2019 03; 67(3):449-454.JA

Abstract

BACKGROUND

Guidelines recommend avoidance of several psychoactive medications such as hypnotics in older adults due to their adverse effects. Older patients on hemodialysis may be particularly vulnerable to complications related to use of these agents, but only limited data are available about the risks in this population.

OBJECTIVES

To evaluate the association between the use of psychoactive medications and time to first emergency department visit or hospitalization for altered mental status, fall, and fracture among older patients receiving hemodialysis.

DESIGN

Observational cohort study.

SETTING

National registry of patients receiving hemodialysis (US Renal Data System).

PARTICIPANTS

A total of 60 007 adults 65 years or older receiving hemodialysis with Medicare Part D coverage in 2011.

MEASUREMENTS

The predictors were use of sedative-hypnotics and anticholinergic antidepressants (modeled as separate time-varying exposures). The outcomes were time to first emergency department visit or hospitalization for altered mental status, fall, and fracture (modeled separately).

RESULTS

Overall, 17% and 6% used sedative-hypnotics and anticholinergic antidepressants, respectively, in 2011. In multivariable-adjusted Cox regression, anticholinergic antidepressant use was associated with a 25%, 27%, and 39% higher hazard of altered mental status, fall, and fracture, respectively, compared with no use. Use of sedative-hypnotics was not associated with adverse outcomes.

CONCLUSION

Anticholinergic antidepressants were associated with adverse outcomes in older hemodialysis patients, and alternative treatments should be considered. Sedative-hypnotics were not associated with the risks evaluated in this study, but further investigation of the harms of this class of agents is warranted before their recommendation as a treatment option for insomnia in this population. J Am Geriatr Soc 67:449-454, 2019.

Authors+Show Affiliations

Department of Medicine, University of California, San Francisco, California. Division of Nephrology, San Francisco VA Medical Center, San Francisco, California.Department of Epidemiology & Biostatistics, University of California, San Francisco, California.Division of Geriatrics, University of California, San Francisco, and San Francisco VA Medical Center, San Francisco, California.Department of Epidemiology & Biostatistics, University of California, San Francisco, California.Department of Medicine, University of California, San Francisco, California. Division of Nephrology, San Francisco VA Medical Center, San Francisco, California. Department of Epidemiology & Biostatistics, University of California, San Francisco, California.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30629740

Citation

Ishida, Julie H., et al. "Psychoactive Medications and Adverse Outcomes Among Older Adults Receiving Hemodialysis." Journal of the American Geriatrics Society, vol. 67, no. 3, 2019, pp. 449-454.
Ishida JH, McCulloch CE, Steinman MA, et al. Psychoactive Medications and Adverse Outcomes among Older Adults Receiving Hemodialysis. J Am Geriatr Soc. 2019;67(3):449-454.
Ishida, J. H., McCulloch, C. E., Steinman, M. A., Grimes, B. A., & Johansen, K. L. (2019). Psychoactive Medications and Adverse Outcomes among Older Adults Receiving Hemodialysis. Journal of the American Geriatrics Society, 67(3), 449-454. https://doi.org/10.1111/jgs.15740
Ishida JH, et al. Psychoactive Medications and Adverse Outcomes Among Older Adults Receiving Hemodialysis. J Am Geriatr Soc. 2019;67(3):449-454. PubMed PMID: 30629740.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psychoactive Medications and Adverse Outcomes among Older Adults Receiving Hemodialysis. AU - Ishida,Julie H, AU - McCulloch,Charles E, AU - Steinman,Michael A, AU - Grimes,Barbara A, AU - Johansen,Kirsten L, Y1 - 2019/01/10/ PY - 2018/06/01/received PY - 2018/10/29/revised PY - 2018/11/08/accepted PY - 2019/1/11/pubmed PY - 2020/3/19/medline PY - 2019/1/11/entrez KW - US Renal Data System KW - anticholinergic antidepressants KW - epidemiology KW - hemodialysis KW - sedative-hypnotics SP - 449 EP - 454 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 67 IS - 3 N2 - BACKGROUND: Guidelines recommend avoidance of several psychoactive medications such as hypnotics in older adults due to their adverse effects. Older patients on hemodialysis may be particularly vulnerable to complications related to use of these agents, but only limited data are available about the risks in this population. OBJECTIVES: To evaluate the association between the use of psychoactive medications and time to first emergency department visit or hospitalization for altered mental status, fall, and fracture among older patients receiving hemodialysis. DESIGN: Observational cohort study. SETTING: National registry of patients receiving hemodialysis (US Renal Data System). PARTICIPANTS: A total of 60 007 adults 65 years or older receiving hemodialysis with Medicare Part D coverage in 2011. MEASUREMENTS: The predictors were use of sedative-hypnotics and anticholinergic antidepressants (modeled as separate time-varying exposures). The outcomes were time to first emergency department visit or hospitalization for altered mental status, fall, and fracture (modeled separately). RESULTS: Overall, 17% and 6% used sedative-hypnotics and anticholinergic antidepressants, respectively, in 2011. In multivariable-adjusted Cox regression, anticholinergic antidepressant use was associated with a 25%, 27%, and 39% higher hazard of altered mental status, fall, and fracture, respectively, compared with no use. Use of sedative-hypnotics was not associated with adverse outcomes. CONCLUSION: Anticholinergic antidepressants were associated with adverse outcomes in older hemodialysis patients, and alternative treatments should be considered. Sedative-hypnotics were not associated with the risks evaluated in this study, but further investigation of the harms of this class of agents is warranted before their recommendation as a treatment option for insomnia in this population. J Am Geriatr Soc 67:449-454, 2019. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/30629740/Psychoactive_Medications_and_Adverse_Outcomes_among_Older_Adults_Receiving_Hemodialysis_ L2 - https://doi.org/10.1111/jgs.15740 DB - PRIME DP - Unbound Medicine ER -