Characteristics of Drug-RElated Hospitalizations for Nursing HOme Residents: Cross-Sectional RENHO Study

Nursing home residents with advancing age are often exposed to polypharmacy, a well-known risk factor for adverse drug reactions (ADRs), which increases the risk of hospitalization. Therefore, we assessed the characteristics of and factors associated with ADR-related emergency department (ED) admissions among nursing home residents.

We carried out a cross-sectional study using the Toulouse University Hospital discharge database to identify nursing home residents ED admissions from 1 April, 2019 to 31 March, 2020. Information was updated for 2 years after inclusion (re-admissions). Emergency department medical files were analyzed to identify factors associated with these admissions (including demographics, functional dependency level, comorbidities, body mass index, ED admission in the previous 12 previous months, and number of drugs).

We identified 1514 patients (corresponding to 2024 ED admissions), 409 of whom (27.0%) were admitted at least once for an ADR. Thirty-six nursing home residents were re-admitted in 2020 and/or 2021 for ADRs, half of whom were for the same ADR. The most frequent ADRs were falls (114, 24.3%), hemorrhagic events (106, 22.6%), and constipation (47, 10.0%) involving benzodiazepines and Z-drugs (170, 16.0%), antidepressants (125, 11.9%), antithrombotic drugs (110, 10.3%), and opioids (82, 7.7%). About 12% of ADRs were assessed as avoidable. Factors significantly associated with ADR-related ED admissions were the number of drugs (odds ratio 1.09; 95% confidence interval 1.05-1.13), previous ED admissions (odds ratio 3.47; 95% confidence interval 2.46-4.90), and overweight (odds ratio 1.54; confidence interval 1.15-2.06).

Drug-induced iatrogenic disease could lead to ED admission for nursing home residents in approximately one-quarter of cases, 12% of which were assessed as avoidable. A previous history of ED admission and polypharmacy remain key associated factors. The awareness-raising campaigns for health professionals should be strengthened to prevent avoidable drug-induced ADRs.