{"id":4090,"date":"2023-01-04T00:00:00","date_gmt":"2023-01-04T05:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\/"},"modified":"2023-11-22T15:30:41","modified_gmt":"2023-11-22T20:30:41","slug":"new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\/","title":{"rendered":"New and persistent sedative prescriptions among older adults after critical illness: a population-based cohort study"},"content":{"rendered":"<p><strong>Background<\/strong> \u2014 ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which ICU survivors are at risk of new sedative use post-hospitalization.<\/p>\n<p><strong>Research Question<\/strong> \u2014 For sedative-na\u00efve older adult ICU survivors, how common is receipt of new and persistent sedative prescriptions, and what factors are associated with receipt?<\/p>\n<p><strong>Study Design and Methods<\/strong> \u2014 Population-based cohort study of ICU survivors \u226566 years who had not filled sedative prescriptions \u22646 months pre-hospitalization (sedative-na\u00efve) in Ontario, Canada (2003 &#8211; 2019). Using multilevel logistic regression, we described demographic, clinical, and hospital characteristics and their association with new sedative prescription \u22647 days of discharge. We quantified variation between hospitals using the adjusted median odds ratio (aMOR). Factors associated with persistent prescriptions (\u22646 months) were examined with multivariable proportional hazards model.<\/p>\n<p><strong>Results<\/strong> \u2014 250,428 patients were included (mean age 76, 61% male). 15,277 (6.1%) filled a new sedative prescription with variation across hospitals (2% (95% CI 1-3) to 44% (3-57)); 8,458 (3.4%) filled persistent sedative prescriptions. Adjusted factors associated with a new sedative included: discharge to long-term care facility (aOR 4.00, 3.72-4.31); receipt of inpatient geriatric (aOR 1.95, 1.80-2.10) or psychiatry (aOR 2.76, 2.62-2.91) consultation, invasive ventilation (aOR 1.59, 1.53-1.66), and ICU length of stay \u22657 days (aOR 1.50, 1.42-1.58). The residual heterogeneity between hospitals (aMOR 1.43, 1.35-1.49) had a stronger association with new sedative prescriptions than Charlson comorbidity score or sepsis. Factors associated with persistent sedative use were similar with the addition of females (sHR 1.07, 1.02-1.13) and pre-existing polypharmacy (sHR 0.88, 0.80-0.93).<\/p>\n<p><strong>Interpretation<\/strong> \u2014 One in 15 sedative-na\u00efve older adult ICU survivors filled a new sedative \u22647 days of discharge, of whom more than half filled persistent prescriptions. New prescriptions at discharge varied widely across hospitals and represent the potential value of modifying prescription practices, including medication review and reconciliation.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background \u2014 ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which ICU survivors are at risk of new sedative use post-hospitalization. Research Question \u2014 For sedative-na\u00efve older adult ICU survivors, how common is receipt of new and persistent sedative prescriptions, and what factors are associated [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[17,56],"migration-helper-qa-sample-set":[],"class_list":["post-4090","journal_article","type-journal_article","status-publish","hentry","topic-older-people","topic-pharmacoepidemiology-and-drug-safety"],"acf":{"citation":"Burry LD, Bell CM, Hill A, Pinto R, Scales DC, Bronskill SE, Williamson D, Rose L, Fu L, Fowler R, Martin CM, Dolovich L, Wunsch H. <em>Chest<\/em>. 2023; 163(6):1425-36. Epub 2023 Jan 4.","source_url":"https:\/\/doi.org\/10.1016\/j.chest.2022.12.033","ices_scientist":[1172,1159,1234,1364,1128,17132],"site":[6733],"research_program":[6740],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"5D248887-B60D-43F2-A698-0F466920092B","sitecore_item_name":"New-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness","sitecore_field_values":"{\r\n  \"Title\": \"New and persistent sedative prescriptions among older adults after critical illness: a population-based cohort study\",\r\n  \"Short title\": \"New and persistent sedative\",\r\n  \"Summary\": \"This study looked at for sedative-na\u00efve older adult ICU survivors, how common is receipt of new and persistent sedative prescriptions, and what factors are associated with receipt?\",\r\n  \"Citation\": \"<p>Burry LD, Bell CM, Hill A, Pinto R, Scales DC, Bronskill SE, Williamson D, Rose L, Fu L, Fowler R, Martin CM, Dolovich L, Wunsch H. <em>Chest<\/em>. 2023; Jan 4 [Epub ahead of print]. DOI: <a href=\"https:\/\/doi.org\/10.1016\/j.chest.2022.12.033\" title=\"opens external link\">https:\/\/doi.org\/10.1016\/j.chest.2022.12.033<\/a><\/p>\",\r\n  \"Abstract\": \"<p><strong>Background<\/strong> &mdash; ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which ICU survivors are at risk of new sedative use post-hospitalization.<\/p>n<p><strong>Research Question<\/strong> &mdash; For sedative-na&iuml;ve older adult ICU survivors, how common is receipt of new and persistent sedative prescriptions, and what factors are associated with receipt?<\/p>n<p><span class=\"bold\">Study Design and Methods<\/span> &mdash; Population-based cohort study of ICU survivors &ge;66 years who had not filled sedative prescriptions &le;6 months pre-hospitalization (sedative-na&iuml;ve) in Ontario, Canada (2003 - 2019). Using multilevel logistic regression, we described demographic, clinical, and hospital characteristics and their association with new sedative prescription &le;7 days of discharge. We quantified variation between hospitals using the adjusted median odds ratio (aMOR). Factors associated with persistent prescriptions (&le;6 months) were examined with multivariable proportional hazards model.<\/p>n<p><strong>Results<\/strong> &mdash; 250,428 patients were included (mean age 76, 61% male). 15,277 (6.1%) filled a new sedative prescription with variation across hospitals (2% (95% CI 1-3) to 44% (3-57)); 8,458 (3.4%) filled persistent sedative prescriptions. Adjusted factors associated with a new sedative included: discharge to long-term care facility (aOR 4.00, 3.72-4.31); receipt of inpatient geriatric (aOR 1.95, 1.80-2.10) or psychiatry (aOR 2.76, 2.62-2.91) consultation, invasive ventilation (aOR 1.59, 1.53-1.66), and ICU length of stay &ge;7 days (aOR 1.50, 1.42-1.58). The residual heterogeneity between hospitals (aMOR 1.43, 1.35-1.49) had a stronger association with new sedative prescriptions than Charlson comorbidity score or sepsis. Factors associated with persistent sedative use were similar with the addition of females (sHR 1.07, 1.02-1.13) and pre-existing polypharmacy (sHR 0.88, 0.80-0.93).<\/p>n<p><strong>Interpretation<\/strong> &mdash; One in 15 sedative-na&iuml;ve older adult ICU survivors filled a new sedative &le;7 days of discharge, of whom more than half filled persistent prescriptions. New prescriptions at discharge varied widely across hospitals and represent the potential value of modifying prescription practices, including medication review and reconciliation.<\/p>\",\r\n  \"ICES Scientists\": \"{9F60496B-63FD-4BE5-A7EF-C4969D7AACB3}|{68FD9EE5-974B-4CED-A597-82186232FF1D}|{C34115AC-9191-4249-9796-3B20B060CFE7}|{E119BD99-4B65-4112-9DEB-3E37C32DBA87}|{C896C802-59A9-4EBD-9C51-CC7C3D35313F}|{AA98AAA4-FB6D-49F8-A479-2072FE76F1D6}\",\r\n  \"Posted Date\": \"20230104T000000\",\r\n  \"Show on Publications Landing Page\": \"1\"\r\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2023\/January\/New-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | New and persistent sedative prescriptions among older adults after critical illness: a population-based cohort study<\/title>\n<meta name=\"description\" content=\"Background \u2014 ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | New and persistent sedative prescriptions among older adults after critical illness: a population-based cohort study\" \/>\n<meta property=\"og:description\" content=\"Background \u2014 ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\/\" \/>\n<meta property=\"og:site_name\" content=\"ICES\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/ICESOntario\/\" \/>\n<meta property=\"article:modified_time\" content=\"2023-11-22T20:30:41+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2024\/11\/ic-es-data-discovery-better-health-logo.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"675\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\\\/\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\\\/\",\"name\":\"ICES | New and persistent sedative prescriptions among older adults after critical illness: a population-based cohort study\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#website\"},\"datePublished\":\"2023-01-04T05:00:00+00:00\",\"dateModified\":\"2023-11-22T20:30:41+00:00\",\"description\":\"Background \u2014 ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\\\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Journal Articles\",\"item\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"New and persistent sedative prescriptions among older adults after critical illness: a population-based cohort study\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#website\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/\",\"name\":\"ICES\",\"description\":\"POPULATION-BASED HEALTH RESEARCH THAT MAKES A DIFFERENCE\",\"publisher\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#organization\"},\"alternateName\":\"Institute for Clinical Evaluative Sciences\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"fr-FR\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#organization\",\"name\":\"ICES\",\"alternateName\":\"Institute for Clinical Evaluative Sciences\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/wp-content\\\/uploads\\\/2023\\\/04\\\/ices-logo.png\",\"contentUrl\":\"https:\\\/\\\/www.ices.on.ca\\\/wp-content\\\/uploads\\\/2023\\\/04\\\/ices-logo.png\",\"width\":\"676\",\"height\":\"618\",\"caption\":\"ICES\"},\"image\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/ICESOntario\\\/\",\"https:\\\/\\\/www.linkedin.com\\\/company\\\/ices-research-institute\\\/\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"ICES | New and persistent sedative prescriptions among older adults after critical illness: a population-based cohort study","description":"Background \u2014 ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\/","og_locale":"fr_FR","og_type":"article","og_title":"ICES | New and persistent sedative prescriptions among older adults after critical illness: a population-based cohort study","og_description":"Background \u2014 ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which","og_url":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\/","og_site_name":"ICES","article_publisher":"https:\/\/www.facebook.com\/ICESOntario\/","article_modified_time":"2023-11-22T20:30:41+00:00","og_image":[{"width":1200,"height":675,"url":"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2024\/11\/ic-es-data-discovery-better-health-logo.jpg","type":"image\/jpeg"}],"twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\/","url":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\/","name":"ICES | New and persistent sedative prescriptions among older adults after critical illness: a population-based cohort study","isPartOf":{"@id":"https:\/\/www.ices.on.ca\/fr\/#website"},"datePublished":"2023-01-04T05:00:00+00:00","dateModified":"2023-11-22T20:30:41+00:00","description":"Background \u2014 ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which","breadcrumb":{"@id":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\/#breadcrumb"},"inLanguage":"fr-FR","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/new-and-persistent-sedative-prescriptions-among-older-adults-after-critical-illness-a-population-based-cohort-study\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.ices.on.ca\/fr\/"},{"@type":"ListItem","position":2,"name":"Journal Articles","item":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/"},{"@type":"ListItem","position":3,"name":"New and persistent sedative prescriptions among older adults after critical illness: a population-based cohort study"}]},{"@type":"WebSite","@id":"https:\/\/www.ices.on.ca\/fr\/#website","url":"https:\/\/www.ices.on.ca\/fr\/","name":"ICES","description":"POPULATION-BASED HEALTH RESEARCH THAT MAKES A DIFFERENCE","publisher":{"@id":"https:\/\/www.ices.on.ca\/fr\/#organization"},"alternateName":"Institute for Clinical Evaluative Sciences","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.ices.on.ca\/fr\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"fr-FR"},{"@type":"Organization","@id":"https:\/\/www.ices.on.ca\/fr\/#organization","name":"ICES","alternateName":"Institute for Clinical Evaluative Sciences","url":"https:\/\/www.ices.on.ca\/fr\/","logo":{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/www.ices.on.ca\/fr\/#\/schema\/logo\/image\/","url":"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2023\/04\/ices-logo.png","contentUrl":"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2023\/04\/ices-logo.png","width":"676","height":"618","caption":"ICES"},"image":{"@id":"https:\/\/www.ices.on.ca\/fr\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/ICESOntario\/","https:\/\/www.linkedin.com\/company\/ices-research-institute\/"]}]}},"_links":{"self":[{"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/journal_article\/4090","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/journal_article"}],"about":[{"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/types\/journal_article"}],"acf:post":[{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/research_program\/6740"},{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/site\/6733"},{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/ices_scientist\/17132"},{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/ices_scientist\/1128"},{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/ices_scientist\/1364"},{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/ices_scientist\/1234"},{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/ices_scientist\/1159"}],"wp:attachment":[{"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/media?parent=4090"}],"wp:term":[{"taxonomy":"migration-helper-automated","embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/migration-helper-automated?post=4090"},{"taxonomy":"migration-manual","embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/migration-manual?post=4090"},{"taxonomy":"topic","embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/topic?post=4090"},{"taxonomy":"migration-helper-qa-sample-set","embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/migration-helper-qa-sample-set?post=4090"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}