Central nervous system medication use around hospitalization.

Area of Science:

• Geriatric Pharmacology
• Health Services Research
• Clinical Pharmacy

Background:

• Central nervous system (CNS) medication use is prevalent in older adults.
• The impact of hospitalizations on CNS medication regimens is not well understood.
• This study investigates CNS medication use patterns and user profiles during hospital stays.

Purpose of the Study:

• To analyze CNS medication use, discontinuations, and user profiles in older adults around hospitalization.
• To identify distinct patient profiles based on CNS medication use across different time points.
• To examine factors influencing transitions between CNS medication use profiles during hospitalization.

Main Methods:

• Retrospective cohort study of patients aged 65 years and older using electronic health records (2018-2020).
• Analysis of CNS medication use from 90 days prior to 90 days after hospitalization.
• Latent class transitions analysis (LCTA) to identify user profiles and transitions across four time points.

Main Results:

• Antidepressants (56%) and opioids (49%) were the most common CNS medications prescribed.
• 74% of patients were persistent users; 7% discontinued CNS medications during hospitalization, with 64% restarting within 90 days post-discharge.
• Three main user profiles were identified: low CNS users (54-60%), mental health users (30-36%), and pain medication users (9-10%).
• Discontinuation was more likely between admission and discharge, especially for pain medication users (9% probability).
• Female gender increased odds, while chronic kidney disease decreased odds of transitioning to low CNS use between admission and discharge.

Conclusions:

• CNS medication use generally remains consistent for older adults around hospitalizations.
• Discontinuation of CNS medications is more probable during the admission-to-discharge period, particularly for pain medication users.
• Further research is warranted to assess the outcomes of hospital deprescribing, especially for medications needing gradual tapering.