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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The work of Agostini et al¹ provides important prospective data suggesting that diphenhydramine use contributes to cognitive decline in hospitalized older patients. It is critical in analyzing this cohort study that the authors account for likely confounding variables, as it is possible that older hospitalized patients who receive diphenhydramine have a disproportionate share of problems that increase delirium risk independent of any effect of the diphenhydramine.

Baseline characteristics of the diphenhydramine-exposed and -nonexposed groups were similar, but the greater exposure of the diphenhydramine-exposed group to anxiolytic, sedative, or hypnotic drugs other than diphenhydramine approached statistical significance (P = .08). Exposure to these drugs might well affect cognitive decline in an acutely ill older person. Does inclusion of this item in the logistic regression model appreciably change the finding of significantly higher risk of cognitive decline in the diphenhydramine-exposed group?

As the indication for diphenhydramine use was sleep in 68% . . . [Full Text of this Article]

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