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Hospitalizations of older people in an emergency department related to potential medication-induced hyperactive delirium: a cross-sectional study

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Abstract

Background Although delirium is one of the most common adverse drug reactions observed in hospitalized older people, it remains underdiagnosed. Aim To estimate the prevalence of hospitalization of older people with potential medication-induced hyperactive delirium in the emergency department (ED); to identify the risk factors and the medicines frequently associated with the occurrence of the syndrome. Method A cross-sectional, retrospective study was performed with older people (age ≥ 60) admitted in 2018 to a Brazilian ED. The hospitalizations with suspected hyperactive delirium were screened with the aid of trigger-tools: International Code of Diseases-10th Revision, intra-hospital prescriptions of antipsychotics, and trigger-words related to the syndrome. A chart-review and medication review were developed to establish the causality assessment between adverse event and medicine. Logistic regression was used to determine risk factors for occurrence. Results Among the hospitalizations included, 67.5% (193/286) were screened by at least one trigger-tool. Of these, potential medication-induced hyperactive delirium was observed in 26.0% (50/193). The prevalence estimated in the ward was 17.5% (50/286). Opioids (31.9%), benzodiazepines (18.8%) and corticosteroids (10.6%) were the commonest medicines associated with delirium. Long-lived patients (p = 0.005), potentially inappropriate medicines (PIMs) (p = 0.025), and high weighted deliriogenic load (p = 0.014) were associated with potential medication-induced hyperactive delirium. Conclusion Approximately one in six hospitalizations of older people in the ED showed potential medication-induced hyperactive delirium. Data suggest PIMs and high weighted deliriogenic load, rather than polypharmacy or anticholinergic burden, are considered the most important characteristics of pharmacotherapy associated with avoidable hyperactive delirium among long-lived patients.

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Funding

This study was partially funded by São Paulo Research Foundation (FAPESP) scholarship Grant No 2019/19430–1.

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Authors and Affiliations

  1. Department of Pharmaceutical Sciences, Research Center for Pharmaceutical Care and Clinical Pharmacy, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Av. do Café, s/n - Vila Monte Alegre, Ribeirão Preto, SP, 14040-900, Brazil

    Júlia Raso, Lincoln Marques Cavalcante Santos, Ariane Cristina Barboza Zanetti, Leonardo Régis Leira Pereira & Fabiana Rossi Varallo

  2. Emergency Unit of the University Hospital of the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil

    Débora Alves Reis

  3. Américo Brasiliense State Hospital, Américo Brasiliense, SP, Brazil

    Marília Amaral Costa Frangiotti

  4. College of Health Sciences of the University of Brasília, Brasília, Brazil

    Helaine Carneiro Capucho

  5. Department of Medical Sciences, iBiMED—Institute of Biomedicine, University of Aveiro, 3800, Aveiro, Portugal

    Maria Teresa Herdeiro

  6. Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), 6300, Guarda, Portugal

    Fátima Roque

  7. Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200, Covilhã, Portugal

    Fátima Roque

Authors
  1. Júlia Raso
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  2. Lincoln Marques Cavalcante Santos
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  3. Débora Alves Reis
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  4. Marília Amaral Costa Frangiotti
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  5. Ariane Cristina Barboza Zanetti
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  6. Helaine Carneiro Capucho
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  7. Maria Teresa Herdeiro
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  9. Leonardo Régis Leira Pereira
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  10. Fabiana Rossi Varallo
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Correspondence to Fabiana Rossi Varallo.

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Raso, J., Santos, L.M.C., Reis, D.A. et al. Hospitalizations of older people in an emergency department related to potential medication-induced hyperactive delirium: a cross-sectional study. Int J Clin Pharm 44, 548–556 (2022). https://doi.org/10.1007/s11096-022-01378-8

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  • DOI: https://doi.org/10.1007/s11096-022-01378-8

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