Deprescribing psychoactive drugs in older orthogeriatric patients: findings from the GIOG2.0 Italian survey

Abstract

Background

Psychoactive drugs represent a major contributor to falls in older people. This study aims to evaluate the prescribing practice of psychoactive drugs in older people hospitalized for hip fracture (HF) and to explore independent correlates of deprescribing.

Methods

Multicenter prospective observational study including patients with HF admitted to 13 Orthogeriatric wards of the Italian Group of Orthogeriatrics (July 2019-August 2022). Patients underwent a comprehensive geriatric assessment. The use of psychoactive drugs associated with a higher risk of falls was assessed using a dedicated checklist. Deprescribing was defined as any reduction in the number of psychoactive drugs upon discharge, and independent correlates of deprescribing were explored using logistic regression analyses. Cluster analysis by Partitioning around Medoids was also performed in the hypothesis that selected clusters of characteristics could be associated with deprescribing.

Results

One thousand eight hundred fifty-four older individuals (mean age 84 years, 77% females) were studied; 1190 (64%) were not prescribed any psychoactive drug, while 474 (26%), 129 (7%), and 61 (3%) took 1, 2, 3 or more psychoactive drugs, respectively.

Among 664 patients on psychoactive drugs on admission, 177 (27%) had fewer prescriptions at discharge, mainly anxiolytics from 89 to 10 (50–6%), antipsychotics from 49 to 12 (28–7%) and antidepressants from 98 to 28 (55–16%). On the other count, 51 (8%) were prescribed more psychoactive drugs, mostly antidepressants from 25 to 45 (49–88%) and antipsychotics from 7 to 17 (14–17%). Functional autonomy (ADL aOR 0.87 [95%CI 0.78–0.97] p < 0.001), polipharmacy (aOR 1.15 [95%CI 1.03–1.29] p < 0.001) and the occurrence of post-operative delirium (aOR 1.71 [95%CI 1.09–2.66] p < 0.017) were independent correlates of deprescribing. More specifically, the clustering procedure could not improve the characterization of deprescribing; conversely, the deprescribing propensity significantly depended upon the center-specific prescriptive practice, not explained by other clinical-epidemiological factors.

Conclusion

Only a small proportion of patients hospitalized for HF undergoes deprescribing of psychoactive drugs, with considerable heterogeneity among centers, suggesting that the physician’s attitude rather than patient-related factors affects deprescribing.