Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026
Glaucoma in hospitalized older adults: polypharmacy, multimorbidity, and therapy discontinuation - a REPOSI registry analysis.
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Quaranta Luciano, Ronchetti Chiara, Nobili Alessandro, Tettamanti Mauro
Аннотация
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.
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.