Advertisement

The journal of nutrition, health & aging

, Volume 23, Issue 4, pp 381–385 | Cite as

Influence of Antipsychotics on Functional Prognosis After Geriatric Hip Fracture

  • Mariko NakamichiEmail author
  • H. Wakabayashi
  • S. Nishioka
  • R. Momosaki
Article

Abstract

Objective

To investigated the effects of antipsychotics on rehabilitation outcomes for geriatric hip fracture inpatients.

Design

Retrospective cohort study.

Setting

The registry data from the Japan Rehabilitation Nutrition Database for analysis.

Participants

Of the 234 patients in the Japan Rehabilitation Nutrition Database admitted between November 2015 and March 2018, 214 met the eligibility criteria.

Measurements

The antipsychotics were phenothiazine, butyrophenone, benzamide, and atypical antipsychotics. For hip fracture patients, the following information was registered: (a) admission data: age, sex, Charlson Comorbidity Index, Functional Independence Measure (FIM) at admission, medications, height, body weight, and Mini Nutritional Assessment-Short Form score (MNA-SF) and (b) discharge data: discharge destination, FIM at discharge, MNASF, and total units of provided rehabilitation therapy (one unit = 20 minutes based on the national healthcare insurance policy).

Results

Thirteen patients (6.1%) were prescribed antipsychotics. According to the multiple linear regression analysis, antipsychotics negatively affected FIM efficiency (β=-0.190, 95% confidence interval, -0.652 to -0.104, p=0.007). Furthermore, on logistic regression analysis, fall during hospitalization was correlated with the use of antipsychotics (odds ratio=4.376, 95% confidence interval: 1.153 to 16.612, p=0.030).

Conclusion

The use of antipsychotics impaired the improvement of the activities of daily living (ADL) and increased the incidence of fall during hospitalization. Reviewing medication therapies at admission may further improve ADL.

Key words

Activities of daily living antipsychotics fall geriatric hip fracture 

References

  1. 1.
    Dyer, SM, Crotty, M, Fairhall, N, Magaziner, J, Beaupre, LA, Cameron, ID, Sherrington C5. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 2016;16:158. doi: 10.1186/s12877-016-0332-02CrossRefGoogle Scholar
  2. 2.
    Hagino, H, Endo, N, Harada, A, Iwamoto, J, Mashiba, T, Mori, S, Ohtori, S, Sakai, A, Takada, J, Yamamoto, T. Survey of hip fractures in Japan: Recent trends in prevalence and treatment. J Orthop Sci 2017;22:909–914. doi: 10.1016/j.jos.2017.06.003CrossRefGoogle Scholar
  3. 3.
    Maher, RL, Hanlon, J, Hajjar, ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 2014;13:57–65. doi: 10.1517/14740338.2013.827660CrossRefGoogle Scholar
  4. 4.
    Härstedt, M, Rogmark, C, Sutton, R, Melander, O, Fedorowski, A. Polypharmacy and adverse outcomes after hip fracture surgery. J Orthop Surg Res 2016;11:1–7. doi: 10.1186/s13018-016-0486-7CrossRefGoogle Scholar
  5. 5.
    Kojima, T, Akishita, M, Nakamura, T, Nomura, K, Ogawa, S, Iijima, K, Eto, M, Ouchi, Y. Polypharmacy as a risk for fall occurrence in geriatric outpatients. Geriatr Gerontol Int 2012;12:425–430. doi: 10.1111/j.1447-0594.2011.00783.xCrossRefGoogle Scholar
  6. 6.
    Lai, SW, Liao, KF, Liao, CC, Muo, CH, Liu, CS, Sung, FC. Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine(Baltimore) 2010;89:295–299. doi: 10.1097/MD.0b013e3181f15efcGoogle Scholar
  7. 7.
    Mangoni, AA, Jackson, SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004;57:6–14. doi: 10.1046/j.1365-2125.2003.02007.xCrossRefGoogle Scholar
  8. 8.
    Kojima, T, Akishita, M, Kameyama, Y, Yamaguchi, K, Yamamoto, H, Eto, M, Ouchi, Y. High risk of adverse drug reactions in elderly patients taking six or more drugs: Analysis of inpatient database. Geriatr Gerontol Int 2012;12:761–762. doi: 10.1111/j.1447-0594.2012.00868.xCrossRefGoogle Scholar
  9. 9.
    Wakabayashi, H. Rehabilitation pharmacotherapy: A combination of rehabilitation and pharmacotherapy. J Gen Fam Med 2018;19:43–44. doi: 10.1002/jgf2.163CrossRefGoogle Scholar
  10. 10.
    Momosaki, R, Maeda, K, Wakabayashi, H. Causal inference from an observational study of geriatric rehabilitation pharmacotherapy. Geriatr Gerontol Int 2018;18:1307–1308. doi: 10.1111/ggi.13470CrossRefGoogle Scholar
  11. 11.
    Kose, E, Hirai, T, Seki, T, Hayashi, H. Role of potentially inappropriate medication use in rehabilitation outcomes for geriatric patients after strokes. Geriatr Gerontol Int 2018;18:321–328. doi: 10.1111/ggi.13187CrossRefGoogle Scholar
  12. 12.
    Nagano, A, Nishioka, S, Wakabayashi, H. Rehabilitation nutrition for iatrogenic sarcopenia and sarcopenic dysphagia. J Nutr Health Aging, 2018. doi: https://doi. org/10.1007/s12603-018-1150-1Google Scholar
  13. 13.
    Iaboni, A, Rawson, K, Burkett, C, Lenze, E, Flint, AJ. Potentially Inappropriate Medications and the Time to Full Functional Recovery After Hip Fracture. Drugs Aging 2017;34:723–728. doi: 10.1007/s40266-017-0482-6CrossRefGoogle Scholar
  14. 14.
    Hershkovitz, A, Angel, C, Brill, S, Nissan, R. The Association between Anticholinergic Drug Use and Rehabilitation Outcome in Post-Acute Hip Fractured Patients: A Retrospective Cohort Study. Drugs Aging 2018;35:333–341. doi: 10.1007/s40266-018-0533-7CrossRefGoogle Scholar
  15. 15.
    Kose, E, Maruyama, R, Okazoe, S, Hayashi, H. Impact of polypharmacy on the rehabilitation outcome of Japanese stroke patients in the convalescent rehabilitation ward. J Aging Res 2016. doi: 10.1155/2016/7957825Google Scholar
  16. 16.
    Kose, E, Hirai, T, Seki, T. Anticholinergic drugs use and risk of hip fracture in geriatric patients. Geriatr Gerontol Int 2018;18:1340–1344. doi: 10.1111/ggi.13486.CrossRefGoogle Scholar
  17. 17.
    Kose, E, Hirai, T, Seki, T. Psychotropic drug use and cognitive rehabilitation practice for elderly patients. Int J Clin Pharm 2018. doi: 10.1007/s11096-018-0718-5.Google Scholar
  18. 18.
    Takasaki, M, Momosaki, R, Wakabayashi, H, Nishioka, S. Construction and Quality Evaluation of the Japanese Rehabilitation Nutrition Database. J Nutr Sci Vitaminol (Tokyo) 2018;64:251–257. doi: 10.3177/jnsv.64.251CrossRefGoogle Scholar
  19. 19.
    Wakabayashi, H, Sakuma, K. Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management. J Cachexia Sarcopenia Muscle 2014;5:269–277. doi: 10.1007/s13539-014-0162-xCrossRefGoogle Scholar
  20. 20.
    Danciu, I, Cowan, JD, Basford, M, Wang, X, Saip, A, Osgood, S, Shirey-Rice, J, Kirby, J, Harris, PA. Secondary use of clinical data: The Vanderbilt approach. J Biomed Inform 2014;52:28–35. doi: 10.1016/j.jbi.2014.02.003CrossRefGoogle Scholar
  21. 21.
    Ottenbacher, KJ, Hsu, Y, Granger C, V, Fiedler, RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil 1996;77:1226–1232.CrossRefGoogle Scholar
  22. 22.
    Herzig, SJ, Rothberg, MB, Guess, JR, Stevens, JP, Marshall, J, Gurwitz, JH, Marcantonio, ER. Antipsychotic use in hospitalized adults: rates, indications, and predictors. J Am Geriatr Soc 2016;64:299–305. doi: 10.1111/jgs.13943CrossRefGoogle Scholar
  23. 23.
    Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle Scholar
  24. 24.
    Rubenstein, LZ, Harker, JO, Salvà, A, Guigoz, Y, Vellas, B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini-Nutritional Assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001;56:366–372.CrossRefGoogle Scholar
  25. 25.
    Kojima, T, Mizukami, K, Tomita, N, Arai, H, Ohrui, T, Eto, M, Takeya, Y, Isaka, Y, Rakugi, H, Sudo, N, Arai, H, Aoki, H, Horie, S, Ishii, S, Iwasaki, K, Takayama, S, Suzuki, Y, Matsui, T, Mizokami, F, Furuta, K, Toba, K, Akishita, M. Screening Tool for Older Persons’ Appropriate Prescriptions in Japanese: Report of the Japan Geriatrics Society Working Group on “Guidelines for medical treatment and its safety in the elderly.” Geriatr Gerontol Int 2016;16:983–1001. doi: 10.1111/ggi.12890CrossRefGoogle Scholar
  26. 26.
    Lee, SJ, Newman, TB, Avorn, J, Fischer, MA, Mogun, H, Solomon, DH, Brookhart, MA. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med 2005;353:2335–2341. doi: 10.1056/NEJMoa052827Google Scholar
  27. 27.
    Takeuchi, H, Suzuki, T, Remington, G, Uchida, H. Antipsychotic Polypharmacy and Corrected QT Interval: A Systematic Review. Can J Psychiatry 2015;60:215–222. doi: 10.1177/070674371506000503CrossRefGoogle Scholar
  28. 28.
    Mauri, MC, Volonteri, LS, Colasanti, A, Fiorentini, A, De Gaspari, IF, Bareggi, SR. Clinical pharmacokinetics of atypical antipsychotics: a critical review of the relationship between plasma concentrations and clinical response. Clin Pharmacokinet 2007;46:359–388. doi: 10.2165/00003088-200746050-00001CrossRefGoogle Scholar
  29. 29.
    Lövheim, H, Sandman, PO, Kallin, K, Karlsson, S, Gustafson, Y. Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care. Int Psychogeriatrics 2006;18:713–726. doi: 10.1017/S1041610206003930CrossRefGoogle Scholar
  30. 30.
    Leipzig, RM, Cumming, RG, Tinetti, ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999;47:40–50.CrossRefGoogle Scholar
  31. 31.
    Fraser, LA, Liu, K, Naylor, KL, Hwang, YJ, Dixon, SN, Shariff, SZ, Garg, AX. Falls and fractures with atypical antipsychotic medication use: a population-based cohort study. JAMA intern med 2015;175:450–452. doi: 10.1001/jamainternmed.2014.6930CrossRefGoogle Scholar
  32. 32.
    Kadra, G, Stewart, R, Shetty, H, Downs, J, MacCabe, JH, Taylor, D, Hayes, RD. Predictors of long-term (=6 months) antipsychotic polypharmacy prescribing in secondary mental healthcare. Schizophr Res 2016;174:106–112. doi: 10.1016/j. schres.2016.04.010CrossRefGoogle Scholar
  33. 33.
    Geller AI, Nopkhun W, Dows-Martinez MN, Strasser DC. Polypharmacy and the Role of Physical Medicine and Rehabilitation. PM R 2012;4:198–219. doi: 10.1016/j.pmrj.2012.02.012CrossRefGoogle Scholar

Copyright information

© Serdi and Springer-Verlag International SAS, part of Springer Nature 2019

Authors and Affiliations

  • Mariko Nakamichi
    • 1
    Email author
  • H. Wakabayashi
    • 2
  • S. Nishioka
    • 3
  • R. Momosaki
    • 4
  1. 1.Department of PharmacyHaradoi HospitalFukuoka cityJapan
  2. 2.Department of Rehabilitation MedicineYokohama City University Medical CenterYokohama cityJapan
  3. 3.Department of Clinical Nutrition and Food ServiceNagasaki Rehabilitation HospitalNagasakiJapan
  4. 4.Department of Rehabilitation MedicineTeikyo University School of Medicine University HospitalKawasaki cityJapan

Personalised recommendations