Luciano Quaranta, Chiara Ronchetti, Alessandro Nobili, Mauro Tettamanti
Anamnestically recorded glaucoma in hospitalized older adults is associated with multimorbidity and polypharmacy. Hospitalization offers opportunities for medication reconciliation and identification of previously unrecorded glaucoma. The 7% discontinuation rate highlights a potential medication discrepancy that warrants further investigation. Findings are limited by absence of ophthalmologic confirmation and inability to distinguish glaucoma types. Précis (30 words): In 9,443 hospitalized older adults, a recorded diagnosis of glaucoma was independently associated with polypharmacy. This association may reflect surveillance bias rather than causality.
PURPOSE: To characterize the clinical profile, multimorbidity burden, medication use, reconciliation patterns, and outcomes of older patients with anamnestically recorded glaucoma or use of anti-glaucoma medications admitted to internal medicine and geriatric wards.
PATIENTS AND METHODS: Prospective observational cohort study of 9,443 patients aged ≥ 65 years enrolled in the REPOSI registry (2008-2017) across 107 Italian hospitals. Patients with anamnestically recorded glaucoma (I = 346, 3.7%) were identified via ICD-9 code 365 or anti-glaucoma medications (ATC S01E). Baseline characteristics, comorbidity, medications, reconciliation, functional status, renal function, and outcomes were compared. Multivariable logistic regression assessed independent associations.
RESULTS: Patients with anamnestically recorded glaucoma had higher medication burden (median 7 vs 5 drugs; P < 0.001) and polypharmacy prevalence (68.8% vs 62.4%; P = 0.016). Anamnestically recorded glaucoma remained independently associated with polypharmacy after adjustment (aOR 1.39; 95% CI 1.08-1.79; P = 0.011). The association was attenuated and no longer significant under a stricter definition (both ICD-9 and medication), suggesting the observed association may be influenced by surveillance bias. Renal function distribution differed (P = 0.040), with fewer glaucoma patients having severe impairment (eGFR < 30: 10.6% vs 14.8%). Notably, 32 patients (9.2%) received their first recorded glaucoma diagnosis during hospitalization. Among 286 patients analyzed for reconciliation, 180 (62.9%) maintained therapy, 20 (7.0%) discontinued, and 5 (1.7%) newly initiated treatment.
CONCLUSIONS: Anamnestically recorded glaucoma in hospitalized older adults is associated with multimorbidity and polypharmacy. Hospitalization offers opportunities for medication reconciliation and identification of previously unrecorded glaucoma. The 7% discontinuation rate highlights a potential medication discrepancy that warrants further investigation. Findings are limited by absence of ophthalmologic confirmation and inability to distinguish glaucoma types. Précis (30 words): In 9,443 hospitalized older adults, a recorded diagnosis of glaucoma was independently associated with polypharmacy. This association may reflect surveillance bias rather than causality.