Association between psychotropic medication use and declines in activities of daily living in previously independent older inpatients: a prospective cohort study

BACKGROUND: Psychotropic medications may impair recovery in older inpatients, but their effect on previously independent patients is unknown. We examined whether admission psychotropic medication use is associated with activities of daily living (ADL) decline at discharge. METHODS: This multicenter prospective cohort study used data from a nine-center hospital-associated disability database collected from February 1, 2023, to March 31, 2025. Patients aged ≥70 years admitted to general medical wards who underwent rehabilitation and were independent of ADL before admission (Katz Index=6) were enrolled. The primary and secondary outcomes were the Katz Index and Food Intake Level Scale (FILS) score at discharge, respectively. One primary multivariable analysis and two sensitivity analyses were performed. Pharmacist-led instruction sessions were also evaluated, and FILS scores were compared by session status. RESULTS: Among 202 patients (mean age, 80.3 years; 39.6% female), 32 (15.8%) used psychotropic medications at admission. In the primary analysis, psychotropic use was independently associated with a lower discharge Katz Index (B = -0.333, p = 0.046). The association was consistent in both sensitivity analyses (Model 1: B = -0.386, p = 0.019; Model 2: B = -0.345, p = 0.020), but not FILS score at discharge (p = 0.970). Any pharmacist-led session was linked to higher FILS scores, without a dose-response pattern. CONCLUSION: Use of psychotropic medications at admission may be a risk factor for ADL decline at discharge in previously independent older inpatients. The patients receiving any instruction session had higher FILS scores than those receiving none.