Associations Between Adverse Outcomes And Medication Causing Dizziness Or Hypotension.:

 Harsharon Kaur Sondh¹, Delia Bishara^2,1, Gayan Perera¹, Hitesh Shetty³, Robert Stewart¹, Christoph Mueller, MD⁴. 

¹Psychological Medicine, King's College London, London, United Kingdom, ²Mental Health of Older Adults and Dementia, South London and Maudsley NHS Foundation Trust, London, United Kingdom, ³South London and Maudsley NHS Foundation Trust, London, United Kingdom, ⁴Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom.

Abstract:
Background: Co-occurring health conditions within people with dementia are common and results in high number of prescribed medication (polypharmacy). Polypharmacy increases the risk of adverse drug reactions and can result in unplanned hospitalisation and increased morbidity and mortality. Dizziness is a common reported side effect of many medications and can contribute to an increased risk of adverse outcomes. Research into polypharmacy in older adults including dementia focuses on grouping medications by their primary indication but little work has been done on outcomes when grouping medications by risk of adverse drug reactions. This study looked to investigate whether medications with dizziness or hypotension were associated with adverse outcomes.
Methods: The South London and Maudsley NHS Foundation Trust (SLaM) Clinical Records Interactive Search (CRIS) platform was used to assemble a cohort of patients diagnosed with dementia. From recorded medications at diagnosis, we ascertained those with dizziness and hypotension (as specific cause for dizziness) listed as side effect. Multivariable Cox regression models were applied to determine risk of emergency general hospitalisation, hospitalisation with a fall, and mortality.
Results: Data from 15,210 patients with a diagnosis of dementia was included within the analysis. 82.2% were prescribed medications causing dizziness and 71.2% a medication causing hypotension at diagnosis. After adjusting for nineteen confounders a dose dependent relationship was found between medications causing dizziness and hypotension and emergency hospitalisation. No associations were found between these medications and mortality, hospitalisation due to falls and cognitive decline. Supplementary analysis was conducted to further investigate medications and seven common causes of hospitalisation. A one unit increase in medication was found to be associated with a higher risk for nearly all of the causes of hospitalisation (except for hypotension medication and musculoskeletal conditions).
Conclusion: Use of medication with dizziness or hypotension as a side effect is common in people with dementia and is associated with an increased risk of emergency hospitalisation. No associations were found with mortality, cognitive decline and hospitalisation due to falls. These findings provide empirical evidence and can be integrated into clinical decision tools such as Medichec to identify individuals at higher risk of adverse drug reactions.