Journal of Aging and Geriatric Psychiatry

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Mortality, inappropriate medication and length of hospital stay in older hip fracture patients: A general population-based cohort study

 Purpose: To assess if potentially inappropriate medication (PIM) or length of hospital stay (LOS)

are related to mortality in older hip fracture patients.
Methods: A population-based cohort study in hip fracture patients’ ≥ 60 years, data from
national registers. Mortality and LOS, were studied in patients exposed to PIM, compared to
un-exposed patients. Beers’ criteria and a corresponding Swedish list were used to identify PIM.
Logistic regression was used and data adjusted for age, sex and polypharmacy.
Results: Of 2043 patients, 81.5% were exposed to PIM. Mortality was higher in males, age ≥
80 years, and with polypharmacy (p<0.001, respectively). Exposure to any PIM was related to
higher adjusted mortality, 30-day odds ratio (OR) 1.79 (95% CI 1.25-2.57) and 90-day 1.57 (95%
CI 1.16-2.12). Exposure to PIM-analgesics (tramadole or dextropropoxyphene) was related to
higher adjusted mortality; 30-day OR 2.59 (95%CI 1.85-3.63), 90-day 1.94 (95%CI 1.50-2.51),
and 180-day 1.62 (95%CI 1.29-2.05). The increase was mainly due to tramadole and this effect
was not seen with other strong analgesics. Adjusted LOS of ≥ 10 days, compared to 0-9 days, was
associated with higher six-month mortality (p<0.001).
Conclusion: Older hip fracture patients are frequently prescribed inappropriate medication,
a potentially avoidable risk factor for adverse outcome. Inappropriate medication, especially
analgesics, and an in-hospital stay of ten days or more can presumably be associated with
higher mortality. To reduce adverse outcomes in older hip fracture patients, it is important to
individually adapt medication, pain management and length of hospital stay.

Author(s): Annika Kragh Ekstam, Isam Atroshi, Solve Elmstahl