Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-18T10:54:57.587Z Has data issue: false hasContentIssue false
  • English
  • Français

Dementia and intentional and unintentional poisoning in older people: a 10 year review of hospitalization records in New South Wales, Australia

Published online by Cambridge University Press:  04 August 2015

Rebecca J. Mitchell ,
Lara A. Harvey ,
Henry Brodaty ,
Brian Draper  and
Jacqueline C. T. Close
Rebecca J. Mitchell*
Affiliation:
Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia Falls and Injury Prevention Group, Neuroscience Research Australia, University of New South Wales, Randwick, Australia
Lara A. Harvey
Affiliation:
Falls and Injury Prevention Group, Neuroscience Research Australia, University of New South Wales, Randwick, Australia
Henry Brodaty
Affiliation:
Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Randwick, Australia Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Randwick, Australia
Brian Draper
Affiliation:
Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Randwick, Australia Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Randwick, Australia
Jacqueline C. T. Close
Affiliation:
Falls and Injury Prevention Group, Neuroscience Research Australia, University of New South Wales, Randwick, Australia Prince of Wales Clinical School, University of New South Wales, Randwick, Australia
*
Correspondence should be addressed to: Rebecca Mitchell, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University NSW 2109, Australia. Phone: +61 2 9850 2321; Fax: +61 2 8088 6234. Email: [email protected].
Get access

Abstract

Background:

Medicinal substances have been identified as common agents of both unintentional and intentional poisoning among older people, including those with dementia. This study aims to compare the characteristics of poisoning resulting in hospitalization in older people with and without dementia and their clinical outcomes.

Methods:

A retrospective cohort study involving an examination of poisoning by intent involving individuals aged 50+ years with and without dementia using linked hospitalization and mortality records during 2003–2012. Individuals who had dementia were identified from hospital diagnoses and unintentional and intentional poisoning was identified using external cause classifications. The epidemiological profile (i.e. individual and incident characteristics) of poisoning by intent and dementia status was compared, along with clinical outcomes of hospital length of stay (LOS), 28-day readmission and 30-day mortality.

Results:

The hospitalization rate for unintentional and intentional poisoning for individuals with dementia was double and 1.5 times higher than the rates for individuals without dementia (69.5 and 31.6 per 100,000) and (56.4 and 32.5 per 1,00,000). The home was the most common location of poisoning. Unintentional poisoning was more likely to involve individuals residing in aged care facilities (OR 2.12; 95%CI 1.70–2.63) or health service facilities (OR 3.91; 95%CI 3.45–4.42). There were higher mortality rates and longer LOS for unintentional poisoning for individuals with dementia.

Conclusions:

Clinicians need to be aware of the risks of poisoning for individuals with dementia and care is required in appropriate prescription, safe administration, and potential for self-harm with commonly used medications, such as anticholinesterase medications, antihypertensive drugs, and laxatives.

Keywords

dementiapoisoningintentionhospitalizationdeath
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 11 , November 2015 , pp. 1757 - 1768
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alzheimer's Disease International (2013). The Global Impact of Dementia 2013–2050. London: Alzheimer's Disease International.Google Scholar
Australian Bureau of Statistics (2014). Australian Demographic Statistics. Cat. No. 3101.0. Canberra: ABS.Google Scholar
Australian Institute of Health and Welfare (2012). People with Dementia in Hospitals in New South Wales, 2006–07. Canberra: AIHW.Google Scholar
Begg, S., Vos, T., Barker, B., Stevenson, C., Stanley, L. and Lopez, A. (2007). The Burden of Disease and Injury in Australia 2003. Canberra: Australian Institute of Health and Welfare.Google Scholar
Bursac, Z., Gauss, C., Williams, D. and Hosmer, D. (2008). Purposeful selection of variables in logistic regression. Source Code for Biology and Medicine, (online) doi: 10.1186/1751-0473-3-17.Google Scholar
Camidge, D., Wood, R. and Bateman, D. (2003). The epidemiology of self-poisoning in the UK. British Journal of Clinical Pharmacology, 56, 613–619.CrossRefGoogle ScholarPubMed
Chan, J., Draper, B. and Banerjee, S. (2007). Deliberate self-harm in older adults: a review of the literature from 1995 to 2004. International Journal of Geriatric Psychiatry, 22, 720–732.Google Scholar
Deloitte Access Economics (2011). Dementia across Australia. Canberra: Deloitte Access Economics.Google Scholar
Dennis, M., Wakefield, P., Molloy, C., Andrews, H. and Friedman, T. (2007). A study of self-harm in older people: mental disorder, social factors and motives. Aging and Mental Health, 11, 520–525.Google Scholar
Doak, M., Nixon, A., Lupton, D. and Waring, S. (2009). Self-poisoning in older adults: patterns of drug ingestion and clinical outcomes. Age and Ageing, 38, 407–411.CrossRefGoogle ScholarPubMed
Draper, B. (1996). Attempted suicide in old age. International Journal of Geriatric Psychiatry, 11, 577–587.Google Scholar
Eddleston, M., Dissanayake, M., Sheriff, M., Warrell, D. and Gunnell, D. (2006). Physical vulnerability and fatal self-harm in the elderly. British Journal of Psychiatry, 189, 278–279.Google Scholar
Elliot, R. (2006). Problems with medication use in the elderly: an Australian perspective. Journal of Pharmacy Practice and Research, 36, 58–66.CrossRefGoogle Scholar
Erlangsen, A., Zarit, S. and Conwell, Y. (2008). Hospital-diagnosed dementia and suicide: a longitudinal study using prospective, nationwide register data. American Journal of Geriatric Psychiatry, 16, 220–228.Google Scholar
Harwood, D., Hawton, K., Hope, T. and Jacoby, R. (2001). Psychiatric disorder and personality factors associated with suicide in older people: a descriptive and case control study. International Journal of Geriatric Psychiatry, 16, 155–165.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
Haw, C., Harwood, D. and Hawton, K. (2009). Dementia and suicidal behavior: a review of the literature. International Psychogeriatrics, 21, 440–453.CrossRefGoogle ScholarPubMed
Hawton, K. and Fagg, J. (1990). Deliberate self-poisoning and self-injury in older people. International Journal of Geriatric Psychiatry, 5, 367–373.Google Scholar
Hawton, K. and Harriss, L. (2006). Deliberate self-harm in people aged 60 years and over: characteristics and outcomes of a 20-year cohort. International Journal of Geriatric Psychiatry, 21, 572–581.Google Scholar
Klein-Schwartz, W. and Oderda, G. (1991). Poisoning in the elderly. Epidemiological, clinical and management considerations. Drugs and Aging, 1, 67–89.CrossRefGoogle ScholarPubMed
Morgan, T., Williamson, M., Pirotta, M., Stewart, K., Myers, S. and Barnes, J. (2012). A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Medical Journal of Australia, 196, 50–53.CrossRefGoogle ScholarPubMed
National Health Performance Authority (2013). Hospital Performance: Length of Stay in Public Hospitals in 2011–12. Technical supplement. Sydney: National Health Performance Authority.Google Scholar
Preen, D., Holman, C. D., Spilsbury, K., Semmens, J. and Brameld, K. (2006). Length of comorbidity lookback period affected regression model performance of administrative health data. Journal of Clinical Epidemiology, 59, 940–946.Google Scholar
Purandare, N., Oude Voshaar, R., Rodway, C., Bickley, H., Burns, A. and Kapur, N. (2009). Suicide in dementia: 9-year national clinical survey in England and Wales. British Journal of Psychiatry, 194, 175–180.Google Scholar
Quan, H. et al. (2011). Updating and validating the charlson comorbidity index and score for risk adjustment in hospital discharge abstracts uing data from 6 countries. American Journal of Epidemiology, 173, 676–682.Google Scholar
Roughead, E., Gilbert, A., Primrose, J. and Sansom, L. (1998). Drug-related hospital admissions: a review of Australian studies published 1988–1996. Medical Journal of Australia, 168, 405–408.CrossRefGoogle ScholarPubMed
Tovell, A., McKenna, K., Bradley, C. and Pointer, S. (2012). Hospital separations due to injury and poisoning, Australia, 2009–10. Injury Research and Statistics Series No.69. Canberra: Australian Institute of Health and Welfare.Google Scholar
United Nations (2013). World Population Ageing: 1950–2050. Retrieved on 27/9/2013 from http://www.un.org/esa/population/publications/worldageing19502050/.Google Scholar
Woolf, A., Fish, S., Azzara, C. and Dean, D. (1990). Serious poisoning among older adults: a study of hospitalisation and mortality rates in Massachusetts 1983–85. Public Health Briefs, 80, 867–869.Google ScholarPubMed
World Health Organization (2014). Dementia Factsheet. Retrieved on 16/11/2014 from http://www.who.int/mediacentre/factsheets/fs362/en/.Google Scholar
Supplementary material: File

Mitchell supplementary material

Table S1

Download Mitchell supplementary material(File)
File 153.6 KB