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Published in: Drugs & Aging 11/2009

01-11-2009 | Original Research Article

Effects of Potent Anticholinergics, Sedatives and Antipsychotics on Postoperative Mortality in Elderly Patients with Hip Fracture

A Retrospective, Population-Based Study

Authors: Dr Jorma Panula, Juha Puustinen, Pekka Jaatinen, Tero Vahlberg, Pertti Aarnio, Sirkka-Liisa Kivela

Published in: Drugs & Aging | Issue 11/2009

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Abstract

Background: Concomitant use of several medications for somatic and mental disorders is common in elderly people and increases the risk of falls, with hip fracture being the most serious consequence.
Objective: The objective of this study was to describe relationships between use of sedatives, antipsychotics or potent anticholinergics and postoperative mortality in patients with hip fractures.
Methods: A retrospective analysis was conducted on population-based data collected during a 2-year period from 1999 to 2000 on 461 hip fracture surgery patients aged ≥65 years in Finland. Information on co-morbidities and intake of sedatives, antipsychotics and potent anticholinergics was obtained from the original patient records. Information on deaths was obtained from the official death statistics in Finland.
Results: In men, use of potent anticholinergics was associated with excess age-adjusted mortality at 30 days, 3 months, 6 months and 3 years, but not in women at any timepoint. Use of potent anticholinergic drugs emerged as an independent predictor of excess mortality in men at 3 months and 3 years. Presence of cardiovascular disease and chronic lung disease were independent risk factors for excess mortality at 6 months and 3 years in men. In addition, chronic lung disease independently predicted excess mortality at 30 days.
Conclusion: Use of potent anticholinergics should be evaluated critically after diseases.
Literature
1.
go back to reference Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319(26): 1701–7PubMedCrossRef Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319(26): 1701–7PubMedCrossRef
2.
go back to reference Lyritis GP. Epidemiology of hip fracture: the MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int 1996; 6Suppl. 3: 11–5PubMedCrossRef Lyritis GP. Epidemiology of hip fracture: the MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int 1996; 6Suppl. 3: 11–5PubMedCrossRef
3.
go back to reference Paksima N, Koval KJ, Aharanoff G, et al. Predictors of mortality after hip fracture: a 10-year prospective study. Bull NYU Hosp Jt Dis 2008; 66(2): 111–7PubMed Paksima N, Koval KJ, Aharanoff G, et al. Predictors of mortality after hip fracture: a 10-year prospective study. Bull NYU Hosp Jt Dis 2008; 66(2): 111–7PubMed
4.
go back to reference Giron MS, Wang HX, Bernsten C, et al. The appropriateness of drug use in an older nondemented and demented population. J Am Geriatr Soc 2001; 49(3): 277–83PubMedCrossRef Giron MS, Wang HX, Bernsten C, et al. The appropriateness of drug use in an older nondemented and demented population. J Am Geriatr Soc 2001; 49(3): 277–83PubMedCrossRef
5.
go back to reference Pomara N, Stanley B, Block R, et al. Increased sensitivity of the elderly to the central depressant effects of diazepam. J Clin Psychiatry 1985; 46(5): 185–7PubMed Pomara N, Stanley B, Block R, et al. Increased sensitivity of the elderly to the central depressant effects of diazepam. J Clin Psychiatry 1985; 46(5): 185–7PubMed
7.
go back to reference Howard L, Kirkwood G, Leese M. Risk of hip fracture in patients with a history of schizophrenia. Br J Psychiatry 2007; 190: 129–34PubMedCrossRef Howard L, Kirkwood G, Leese M. Risk of hip fracture in patients with a history of schizophrenia. Br J Psychiatry 2007; 190: 129–34PubMedCrossRef
8.
go back to reference Allain H, Bentue-Ferrer D, Polard E, et al. Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly: a comparative review. Drugs Aging 2005; 22(9): 749–65PubMedCrossRef Allain H, Bentue-Ferrer D, Polard E, et al. Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly: a comparative review. Drugs Aging 2005; 22(9): 749–65PubMedCrossRef
9.
go back to reference Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry 2001; 62Suppl. 21: 11–4PubMed Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry 2001; 62Suppl. 21: 11–4PubMed
10.
go back to reference French DD, Campbell R, Spehar A, et al. Outpatient medications and hip fractures in the US: a national veterans study. Drugs Aging 2005; 22(10): 877–85PubMedCrossRef French DD, Campbell R, Spehar A, et al. Outpatient medications and hip fractures in the US: a national veterans study. Drugs Aging 2005; 22(10): 877–85PubMedCrossRef
12.
go back to reference World Health Organization. Tautiluokitus ICD-10 (Classification of Diseases ICD-10). Rauma: Kirjapaino Oy West Point, 1995 World Health Organization. Tautiluokitus ICD-10 (Classification of Diseases ICD-10). Rauma: Kirjapaino Oy West Point, 1995
13.
go back to reference National Agency of Medicines. Classification of medicines (ATC) and defined daily doses (DDD) 2004. Helsinki: National Agency of Medicines, 2004 National Agency of Medicines. Classification of medicines (ATC) and defined daily doses (DDD) 2004. Helsinki: National Agency of Medicines, 2004
14.
go back to reference Pollock BG. Psychotropic drugs and the aging patient. Geriatrics 1998; 53Suppl. 1: S20–4PubMed Pollock BG. Psychotropic drugs and the aging patient. Geriatrics 1998; 53Suppl. 1: S20–4PubMed
15.
go back to reference Kay GG, Abou-Donia MB, Messer WS, et al. Anti-muscarinic drugs for overactive bladder and their potential effects on cognitive function in older patients. J Am Geriatr Soc 2005; 53(12): 2195–201PubMedCrossRef Kay GG, Abou-Donia MB, Messer WS, et al. Anti-muscarinic drugs for overactive bladder and their potential effects on cognitive function in older patients. J Am Geriatr Soc 2005; 53(12): 2195–201PubMedCrossRef
16.
go back to reference Wehren LE, Hawkes WG, Orwig DL, et al. Gender differences in mortality after hip fracture: the role of infection. J Bone Miner Res 2003; 18(12): 2231–7PubMedCrossRef Wehren LE, Hawkes WG, Orwig DL, et al. Gender differences in mortality after hip fracture: the role of infection. J Bone Miner Res 2003; 18(12): 2231–7PubMedCrossRef
17.
go back to reference Poor G, Atkinson EJ, O’Fallon WM, et al. Determinants of reduced survival following hip fractures in men. Clin Orthop Relat Res 1995; (319): 260–5PubMed Poor G, Atkinson EJ, O’Fallon WM, et al. Determinants of reduced survival following hip fractures in men. Clin Orthop Relat Res 1995; (319): 260–5PubMed
18.
go back to reference Singh S, Loke YK, Furberg CD. Inhaled anticholiner-gics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA 2008; 300(12): 1439–50PubMedCrossRef Singh S, Loke YK, Furberg CD. Inhaled anticholiner-gics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA 2008; 300(12): 1439–50PubMedCrossRef
19.
go back to reference Herrmann N, Lanctot KL. Atypical antipsychotics for neuropsychiatric symptoms of dementia: malignant or maligned? Drug Saf 2006; 29(10): 833–43PubMedCrossRef Herrmann N, Lanctot KL. Atypical antipsychotics for neuropsychiatric symptoms of dementia: malignant or maligned? Drug Saf 2006; 29(10): 833–43PubMedCrossRef
20.
go back to reference Laaksonen M, Uutela A, Vartiainen E, et al. Development of smoking by birth cohort in the adult population in eastern Finland 1972-97. Tob Control 1999; 8(2): 161–8PubMedCrossRef Laaksonen M, Uutela A, Vartiainen E, et al. Development of smoking by birth cohort in the adult population in eastern Finland 1972-97. Tob Control 1999; 8(2): 161–8PubMedCrossRef
21.
go back to reference Hartikainen S, Ahto M, Lopponen M, et al. Change in the prevalence of coronary heart disease among Finnish elderly men and women in the 1990s. Scand J Prim Health Care 2003; 21(3): 178–81PubMedCrossRef Hartikainen S, Ahto M, Lopponen M, et al. Change in the prevalence of coronary heart disease among Finnish elderly men and women in the 1990s. Scand J Prim Health Care 2003; 21(3): 178–81PubMedCrossRef
22.
go back to reference Mattila VM, Sillanpaa P, Iivonen T, et al. Coverage and accuracy of diagnosis of cruciate ligament injury in the Finnish National Hospital Discharge Register. Injury 2008; 39(12): 1373–6PubMedCrossRef Mattila VM, Sillanpaa P, Iivonen T, et al. Coverage and accuracy of diagnosis of cruciate ligament injury in the Finnish National Hospital Discharge Register. Injury 2008; 39(12): 1373–6PubMedCrossRef
23.
go back to reference Holmes JD, House AO. Psychiatric illness in hip fracture. Age Aging 2000; 29(6): 537–46CrossRef Holmes JD, House AO. Psychiatric illness in hip fracture. Age Aging 2000; 29(6): 537–46CrossRef
24.
go back to reference Hosia-Randell H, Pitkala K. Use of psychotropic drugs in elderly nursing home residents with and without dementia in Helsinki, Finland. Drugs Aging 2005; 22(9): 793–800PubMedCrossRef Hosia-Randell H, Pitkala K. Use of psychotropic drugs in elderly nursing home residents with and without dementia in Helsinki, Finland. Drugs Aging 2005; 22(9): 793–800PubMedCrossRef
25.
go back to reference Puustinen J, Nurminen J, Kukola M, et al. Associations between use of benzodiazepines or related drugs and health, physical abilities and cognitive function: a non-randomised clinical study in the elderly. Drugs Aging 2007; 24(12): 1045–59PubMedCrossRef Puustinen J, Nurminen J, Kukola M, et al. Associations between use of benzodiazepines or related drugs and health, physical abilities and cognitive function: a non-randomised clinical study in the elderly. Drugs Aging 2007; 24(12): 1045–59PubMedCrossRef
26.
go back to reference Schor JD, Levkoff SE, Lipsitz LA, et al. Risk factors for delirium in hospitalized elderly. JAMA 1992; 267(6): 827–31PubMedCrossRef Schor JD, Levkoff SE, Lipsitz LA, et al. Risk factors for delirium in hospitalized elderly. JAMA 1992; 267(6): 827–31PubMedCrossRef
27.
go back to reference Berggren D, Gustafson Y, Eriksson B, et al. Postoperative confusion after anesthesia in elderly patients with femoral neck fractures. Anesth Analg 1987; 66(6): 497–504PubMedCrossRef Berggren D, Gustafson Y, Eriksson B, et al. Postoperative confusion after anesthesia in elderly patients with femoral neck fractures. Anesth Analg 1987; 66(6): 497–504PubMedCrossRef
28.
go back to reference Magaziner J, Simonsick EM, Kashner TM, et al. Survival experience of aged hip fracture patients. Am J Public Health 1989; 79(3): 274–8PubMedCrossRef Magaziner J, Simonsick EM, Kashner TM, et al. Survival experience of aged hip fracture patients. Am J Public Health 1989; 79(3): 274–8PubMedCrossRef
29.
go back to reference Bass E, French DD, Bradham DD, et al. Risk-adjusted mortality rates of elderly veterans with hip fractures. Ann Epidemiol 2007; 17(7): 514–9PubMedCrossRef Bass E, French DD, Bradham DD, et al. Risk-adjusted mortality rates of elderly veterans with hip fractures. Ann Epidemiol 2007; 17(7): 514–9PubMedCrossRef
30.
go back to reference French DD, Bass E, Bradham DD, et al. Rehospitalization after hip fracture: predictors and prognosis from a national veterans study. J Am Geriatr Soc 2008; 56(4): 705–10PubMedCrossRef French DD, Bass E, Bradham DD, et al. Rehospitalization after hip fracture: predictors and prognosis from a national veterans study. J Am Geriatr Soc 2008; 56(4): 705–10PubMedCrossRef
Metadata
Title
Effects of Potent Anticholinergics, Sedatives and Antipsychotics on Postoperative Mortality in Elderly Patients with Hip Fracture
A Retrospective, Population-Based Study
Authors
Dr Jorma Panula
Juha Puustinen
Pekka Jaatinen
Tero Vahlberg
Pertti Aarnio
Sirkka-Liisa Kivela
Publication date
01-11-2009
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 11/2009
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.2165/11317660-000000000-00000

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