SHM Converge Scientific Abstract ePoster Gallery-Central Nervous System Medications as Targets for Hospital Deprescribing

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This retrospective cohort study examined central nervous system (CNS) medication use before, during, and after hospitalization among community-dwelling adults aged 65 and older admitted to general medicine at Duke University from 2018–2020. Using electronic health record data, researchers followed patients prescribed at least one outpatient CNS medication within 90 days before to 90 days after hospitalization. CNS drugs included antianxiety agents, anticholinergics, anticonvulsants, antidepressants, antipsychotics, hypnotics, muscle relaxants, and opioids.<br /><br />The study aimed to describe patterns of CNS medication use around hospitalization and identify factors linked to initiation or deprescribing. Latent transition analysis was used to identify medication-use profiles at four time points: 90 days before admission, admission, discharge, and 90 days after discharge.<br /><br />Key findings showed that most patients remained persistent users of CNS medications across the hospitalization period. Deprescribing was uncommon overall, with only about 5–9% of patients starting deprescribing during hospitalization. The study found that 7% had a CNS medication deprescribed in the hospital, which was more frequent than at other time points but still low. Of those whose CNS medications were deprescribed during hospitalization, 64% had a CNS medication started or restarted within 90 days after discharge. After hospitalization, prescribing outpaced deprescribing.<br /><br />Three CNS medication-use profiles were identified, and patients were highly likely to remain in the same group over time (probability 0.88–1.00). The likelihood of deprescribing was greatest during hospitalization and was highest among patients using pain-related CNS medications such as opioids and muscle relaxants.<br /><br />Overall, the study suggests hospitalization is a potential but underused opportunity for CNS medication deprescribing, and more research is needed to assess the benefits and harms of such efforts.

Asset Subtitle

Juliessa M. Pavon

Meta Tag

Author List Carl Pieper, Cathleen Colon-Emeric, David Gallagher, Juliessa M. Pavon, Kenneth Schmader, Richard Sloane, Susan N. Hastings

Category Research

Concept Central Nervous System Medication

Concept Deprescribing

Concept Hospitalization

Concept Medication Re-initiation

Concept Medication Use Profile

Distinguished Non-Finalist

Presenter Organization Duke University

Presenting Author Juliessa M. Pavon

Track Geriatrics

Keywords

central nervous system medications

hospitalization

deprescribing

older adults

retrospective cohort study

latent transition analysis

electronic health records

opioids

muscle relaxants

medication use patterns

Central Nervous System Medication

Deprescribing

Hospitalization

Medication Re-initiation

Medication Use Profile