(P67) Hierarchical Association Between Beers List Medications, Delirium, Post-Acute Care Discharge

Introduction/

Objective: The Beers criteria are the most widely cited resource used to identify potentially inappropriate medication prescribing in older adults. This is of interest as Beers list medications may contribute to higher rates of delirium when used in hospitalized patients. Delirium is an acute disturbance of attention and cognition that is more common in older adults and can have potentially serious and long-term health implications. Previous research has highlighted its negative effect on health outcomes, hospitalizations, healthcare costs, and mortality. The purpose of this study is to evaluate the association of in-hospital prescribing of a subset of commonly used Beers list medications with the risk of having a Confusion Assessment Method (CAM) positive screen and the risk of being discharged to a post-acute care facility.

Design/Methodology: This is a single center, retrospective cohort study from an academic hospital in Charleston, SC. All hospital admissions from August 2018 to January 2020 were analyzed for delirium and receipt of Beers list medications. The CAM, a validated tool used for identifying delirium, was used to assess patients twice daily and documented in the electronic medical record. Potentially inappropriate medications were defined according to the American Geriatrics Society (AGS) 2019 Beers Criteria. A post-acute care facility was defined as any discharge destination other than home. Multivariable logistic regressions were used to analyze the association of delirium and medication receipt. Subsequent analysis looked at the receipt of medication with or without delirium and the likelihood of being discharged to a facility.

Results: 34,083 admissions were included in this study. 60.4% (n=20,598) were age 18-64, and 39.6% (n=13,485) were age 65 or older. 91.2% of patients 18-64 years old received a Beers Criteria medication, and 88.3% of patients older than 65 years received a Beers Criteria medication. The odds ratio of a patient having a positive CAM score during the admission when receiving a benzodiazepine, opioid, antipsychotic, or anticholinergic medication was 1.56, 0.9, 1.42, and 1.25 respectively. The odds ratio of a patient being discharged to a post-acute care facility when receiving a benzodiazepine, opioid, antipsychotic, or anticholinergic medication was 1.2, 1.09, 1.51, and 1.21 respectively.

Conclusion/

Discussion: Most patients received Beers Criteria medications during their hospitalization. When looking closer at specific classes of medications, a patient who received a benzodiazepine, antipsychotic, or anticholinergic medication was more likely to develop delirium and be discharged to a post-acute care facility. Opioids did not significantly increase the risk of these outcomes. These results should continue to motivate de-prescribing efforts for these specific medications.