We all know clinicians should avoid prescribing inappropriate medications for older adults, but medication review after hospital discharge remains one of the most overlooked opportunities to prevent unnecessary harm. Medications with limited effectiveness can lead to adverse events that require additional health care services. Serious adverse events associated with sedative and antipsychotic use include falls, fractures, delirium, cognitive impairment, and death. Yet hospitals frequently prescribe these medications to support diagnostic or therapeutic interventions and to manage sleep disturbances, anxiety, and delirium.
Researchers recently reported in the Canadian Medical Association Journal that new sedative prescriptions after hospitalization increased the risk of falls and emergency department visits in older adults. This reinforces the importance of carefully evaluating these medications before continuing them in a senior living community.
Consider this common scenario. A hospital discharges a resident with orders for an antipsychotic medication or sedative. No supporting diagnosis justifies the medication, yet staff send the order to the pharmacy and continue it without question. This creates a vicious cycle of inappropriate medication use. I am not a big proponent of introducing these medications in the hospital either. Many times, they can contribute to a resident’s delirium rather than helping resolve it.
In a perfect world, every admission and readmission would include a complete medication review by the attending physician or physician extender. The attending physician or physician extender should evaluate every medication that is new to the resident for its diagnosis, ongoing need, and effectiveness. This process is often simpler during a readmission because there is a medication history for comparison.
For new admissions, however, one simple question can be incredibly valuable: “Was your mom on this medication before going to the hospital?” If the answer is no, clinicians should take another look at the medication and discontinue it unless a supporting diagnosis justifies its continued use. A diagnosis of hospital-acquired delirium alone should not automatically lead to long-term antipsychotic or sedative therapy.
A thoughtful medication review after hospital discharge can help identify medications that no longer serve a purpose before they become part of a resident’s long-term regimen. A recent McKnight’s Long-Term Care News article highlighted research showing that older adults who received new sedative prescriptions after hospitalization experienced more falls and emergency department visits within 30 days of discharge.
If preventing inappropriate medication use were easy, everyone would be doing it. Asking a few thoughtful questions during admission can make all the difference.
Stay well and stay informed!
