Use of a trigger tool to describe and screen drug-related hospital admissions in older adults: the TRIGGAge retrospective cohort study

Abstract Introduction Drug-related hospital admissions (DRAs) can account for 5%–40% of total hospital admissions in older adults, with a significant proportion deemed preventable. To increase the detection of DRAs, in 2021, a revised trigger tool listing 21 frequent causes of admissions and medications at risk was proposed. This study aimed to describe DRAs using this trigger tool in a French acute geriatric ward and to assess the performance of the tool. Methods This was a retrospective cohort study in a 20-bed geriatric unit including all patients hospitalised in 2023. During the first quarter of 2024, each patient’s chart was adjudicated by using a two-step standardised review procedure to assess whether the admission was a DRA. The potentially at cause medications and reasons for admission were also assessed. Results During the study period, 483 patients were hospitalised in the acute-care geriatric ward (mean age 86.7 ± 6.15 years). After adjudication, 207 admissions (43%) were identified as DRAs; 70% were considered preventable. The main causes of DRAs were falls/fractures (33%), bleeding (23%) and delirium (14%). The drugs most frequently responsible were diuretics (21%), renin–angiotensin system inhibitors (20%) and direct oral anticoagulants (15%). The overall sensitivity and specificity of the tool for detecting DRAs was 90% (95% CI 88–93) and 72% (68–76), respectively. After adjudication, the trigger tool helped detect 83% more DRAs as compared with the attending geriatrician. Conclusion DRAs are frequent in a geriatric population and often preventable. Their detection may be improved by the use of a trigger tool.