Benzodiazepine and antipsychotic use among hospitalized older adults before versus after restricting visitation: March to May 2020.
Benzodiazepine and antipsychotic use among hospitalized older adults before versus after restricting visitation: March to May 2020.
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DOI：
10.1111/jgs.17947
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发表时间：
2022-10
影响因子：
6.3
通讯作者：
Ryskina, Kira L.
中科院分区：
文献类型：
--
作者：
Brown, Rebecca T.;Shultz, Kaitlyn;Karlawish, Jason;Zhou, Yi;Xie, Dawei;Ryskina, Kira L.
COVID-19大流行期间的医院探视限制引发了人们对老年患者意外后果的担忧，包括谵妄和躁动的发生率增加。虽然针对这些疾病的一线干预是非药物性的，但缺乏家庭支持可能导致苯二氮卓类药物和抗精神病药物的使用增加，这与老年人预后不良有关。很少有人知道探视政策与老年人使用这些药物之间的关系。我们对2020年3月1日至5月31日在大西洋中部四家医院住院的年龄≥65岁的成年人进行了一项回顾性横断面研究。从医院管理人员处收集了开始限制探视的日期（即全院禁止探视的指导方针）。结果是使用苯二氮卓类药物和抗精神病药物，使用患者级电子健康记录数据进行评估。采用多变量logistic回归与医院和学习日固定效应，准实验研究设计利用跨医院的错开探视限制来衡量在允许探视和不允许探视时接受每种药物的几率。在2931例患者中，平均年龄为76.6岁（SD, 8.3）， 51.6%为女性，58.6%为白人，32.5%为黑人，2.6%为西班牙裔。总体而言，924名（31.5%）患者接受了苯二氮卓类药物治疗，298名（10.2%）患者接受了抗精神病药物治疗。在允许探视者与不允许探视者使用苯二氮卓类药物的调整后几率较低（调整后优势比[AOR]， 0.62; 95% CI, 0.39, 0.99）。抗精神病药物的使用在允许探视者与不允许探视者之间没有显著差异（AOR, 0.98; 95% CI, 0.43, 2.21）。在第一波大流行期间住院的老年患者中，在允许访客的日子里，苯二氮卓类药物的使用量较低。这些发现表明，护理人员的存在会影响住院老年人使用可能不适当的药物，支持将护理人员视为护理团队重要成员的努力。
Hospital visitation restrictions during the COVID-19 pandemic prompted concerns about unintended consequences for older patients, including an increased incidence of delirium and agitation. While first-line interventions for these conditions are non-pharmacologic, a lack of family support could result in increased use of benzodiazepines and antipsychotics, which are associated with poor outcomes in older adults. Little is known about the association of visitation policies with use of these medications among older adults. We conducted a retrospective cross-sectional study among adults age ≥65 hospitalized from March 1 through May 31, 2020 at four hospitals in the Mid-Atlantic. The dates of onset of visitation restrictions (i.e., hospital-wide guidelines barring visitors) were collected from hospital administrators. Outcomes were use of benzodiazepines and antipsychotics, assessed using patient-level electronic health record data. Using multivariable logistic regression with hospital and study-day fixed effects, the quasi-experimental study design leveraged the staggered onset of visitation restrictions across the hospitals to measure the odds of receiving each medication when visitors were vs were not allowed. Among 2,931 patients, mean age was 76.6 years (SD, 8.3), 51.6% were female, 58.6% white, 32.5% Black, and 2.6% Hispanic. Overall, 924 (31.5%) patients received a benzodiazepine and 298 (10.2%) an antipsychotic. The adjusted odds of benzodiazepine use was lower on days when visitors were vs were not allowed (adjusted odds ratio [AOR], 0.62; 95% CI, 0.39, 0.99). Antipsychotic use did not significantly differ between days when visitors were vs were not allowed (AOR, 0.98; 95% CI, 0.43, 2.21). Among older patients hospitalized during the first wave of the pandemic, benzodiazepine use was lower on days when visitors were allowed. These findings suggest that the presence of caregivers impacts use of potentially inappropriate medications among hospitalized older adults, supporting efforts to recognize caregivers as essential members of the care team.
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影响因子：
158.5
作者：
Inouye, SK;Bogardus, ST;Cooney, LW
通讯作者：
Cooney, LW
影响因子：
39
作者：
Hshieh, Tammy T.;Yue, Jirong;Oh, Esther;Puelle, Margaret;Dowal, Sarah;Travison, Thomas;Inouye, Sharon K.
通讯作者：
Inouye, Sharon K.
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
DOI：
10.1097/phh.0000000000001320
发表时间：
2022-01-01
影响因子：
3.3
作者：
Jaswaney, Rohit;Davis, Arlene;Joyner, Benny L., Jr.
通讯作者：
Joyner, Benny L., Jr.
影响因子：
5.7
作者：
Bell, Chaim M.;Fischer, Hadas D.;Rochon, Paula A.
通讯作者：
Rochon, Paula A.