Association of skeletal muscle relaxers and antihistamines on mortality, hospitalizations, and emergency department visits in elderly patients: a nationwide retrospective cohort study

BMC Geriatrics

Mary Jo V Pugh³  Megan E Amuan²  Chester B Good¹  Laurel A Copeland⁶  Dan R Berlowitz²  Una E Makris⁴  Eric M Mortensen⁴  Carlos A Alvarez⁵ 

[1]Departments of Medicine and Pharmacy, University of Pittsburgh, University Dr C, Pittsburgh, PA, USA

[2]Center for Healthcare Organization and Implementation Research, Springs Rd, Bedford, MA, USA

[3]South Texas Veterans Healthcare System and the Department of Epidemiology and Biostatistics at the University of TX Health Science Center, San Antonio, TX, USA

[4]Internal Medicine Department, University of Texas Southwestern, Harry Hines, Dallas, TX, USA

[5]Clinical Science Department, University of Texas Southwestern, Harry Hines, Dallas, TX, USA

[6]Center for Applied Health Research – Health Outcomes Core, Central Texas Veterans Health Care System and Baylor Scott & White Health, Birdcreek Dr, Temple, TX, USA

关键词: Emergency service;    Hospitalizations;    Mortality;    Healthcare effectiveness data and information set;    Adverse drug events;    Skeletal muscle relaxant;    Antihistamines;    Aged;   

Others  :  1089770
DOI  :  10.1186/1471-2318-15-2

 received in 2014-06-04, accepted in 2014-12-17,  发布年份 2015

【 摘 要 】

Background

High-risk medication exposure in the elderly is common and associated with increased mortality, hospitalizations, and emergency department (ED) visits. Skeletal muscle relaxants and antihistamines are high-risk medications commonly prescribed in elderly patients. The objective of this study was to determine the association between skeletal muscle relaxants or antihistamines and mortality, hospitalizations, and emergency department visits.

Methods

This study used a new-user, retrospective cohort design using national Veteran Affairs (VA) data from 128 hospitals. Veterans ≥65 years of age on October 1, 2005 who received VA inpatient/outpatient care at least once in each of fiscal year (FY) 2005 and FY 2006 were included. Exposure to skeletal muscle relaxants and antihistamines was defined by the National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set measures for high-risk medications in the elderly. Primary outcomes identified within one year of exposure were death, ED visit, or hospitalization; ED visits or hospitalizations due to falls and fracture were also assessed. Propensity score matching (1 to 1 match) was used to balance covariates between exposed patients and non-exposed patients.

Results

In this cohort of 1,807,404 patients 55,566 patients were included in the propensity-matched cohort for skeletal muscle relaxants and 60,058 patients were included in the propensity-matched cohort for anti-histamines. Mortality was lower in skeletal muscle relaxants-exposed patients (adjusted odds ratio [AOR] 0.87, 95% CI 0.81-0.94), but risk of emergency care (AOR 2.25, 95% CI 2.16-2.33) and hospitalization (AOR 1.56, 95% CI 1.48-1.65) was higher for patients prescribed skeletal muscle relaxants. Similar findings were observed for emergency and hospital care for falls or fractures. Mortality (AOR 1.93, 95% CI 1.82-2.04), ED visits (AOR 2.35, 95% CI 2.27-2.43), and hospitalizations (AOR 2.21, 95% CI 2.11-2.32) were higher in the antihistamine-exposed group, with similar findings for falls and fractures outcomes.

Conclusion

Skeletal muscle relaxants and antihistamines are associated with an increased risk of ED visits and hospitalizations in elderly patients. Antihistamines were also associated with an increased risk of death, further validating the classification of these drug classes as “high risk”.

【 授权许可】

   
2015 Alvarez et al.; licensee BioMed Central.

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