Initiation of cholinesterase inhibitors in an inpatient setting

We examined initiation of cholinesterase inhibitors (ChEIs) to determine whether ChEIs were being newly prescribed without sufficient evaluation for dementia and/or delirium and to explore whether there are differences in outcomes, such as mortality, hospital readmission rates, and duration of hospitalization, between patients newly started on ChEI and those who continued such medications prior to admission. Patients hospitalized in fiscal year 2008 and prescribed ChEI were identified. We reviewed electronic medical records. Of 282 patients, 15.6% (44) were new-starts and 84.4% (238) were continuations. Median length of stay was 16 days in new-starts versus 6 days in continuations (P <.05). Of new-starts, 38.6% were also treated of infection. Chart review additionally suggested possible treatment of delirium by initiation of benzodiazepines and antipsychotics in 11.4% and 22.7% of new-starts, respectively. We observed a substantive practice of initiating ChEIs in hospitalized elderly patients at risk of delirium. Although there was no difference in the 30-day mortality or readmission rates, new-starts were more likely to have a longer hospital stay than continuation patients.