Risk of Death Associated with Antipsychotic Drug Dispensing in Residential aged Care Facilities

Hollis, Jean; Forrester, Loelle; Brodaty, Henry; Touyz, Stephen; Cumming, Robert; Grayson, David

doi:10.1080/00048670701519864

Cited by 17 publications

(16 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…9–11,13,24 No previously conducted study has successfully controlled for all of these factors. For example, a study by Hollis et al 24 inferred comorbidity from prescription drug claims data and was, therefore, unable to measure factors beyond overall morbidity and drug burden. Gill et al 10 and Rochon et al 9 used propensity scores for comorbidity and drug burden, whereas Liperoti et al 13 controlled for several health-related factors (behavior problems, functional status, body mass index, concomitant medications, and comorbidity) using information from the Systematic Assessment of Geriatric Drug Use via Epidemiology database.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of Antipsychotic Use With Hospital Events and Mortality Among Medicare Beneficiaries Residing in Long-Term Care Facilities

Simoni

Ryder

Qian

et al. 2009

The American Journal of Geriatric Psychiatry

View full text Add to dashboard Cite

Objective Antipsychotic (AP) utilization has grown significantly in long-term care (LTC) settings. Although a growing literature associates AP use with higher mortality in elderly with dementia, the association of APs with hospital events is unclear. The authors examine prevalence and trends in AP use by Medicare beneficiaries residing in LTC and the association of APs and other drug use variables with hospital events and mortality. Design Retrospective analysis using sequential multivariate Cox proportional hazards models. Setting Medicare Current Beneficiary Survey linked to Institutional Drug Administration and Minimum Data Set files. Participants A total of 2,363 LTC Medicare beneficiaries, 1999–2002. Measurements Trends in LTC AP use overall and by type and duplicative use; association of AP utilization and two outcomes: hospital events and all-cause mortality. Results AP use rose markedly from 1999 to 2002 (26.4%–35.9%), predominantly due to increased use of atypical agents. After controlling for sociodemographic and clinical factors, AP use is not related to hospital events (hazard ratio [HR] = 0.98, 95% confidence interval [CI] = 0.82–1.63 p = 0.7951). AP use is associated with reduced mortality in unadjusted and intermediate models, but loss of significance in the final model (HR = 0.83, 95% CI = 0.69–1.00, p = 0.0537) suggests that disease and drug burden factors may confound the AP-mortality relationship. Conclusion This study provides no evidence of increased hospital events or mortality in LTC residents who use AP medications. Findings contribute to a growing body of evidence that APs, particularly atypical agents, may be associated with reduced mortality in LTC residents.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Antipsychotic Use With Hospital Events and Mortality Among Medicare Beneficiaries Residing in Long-Term Care Facilities

Simoni

Ryder

Qian

et al. 2009

The American Journal of Geriatric Psychiatry

View full text Add to dashboard Cite

show abstract

“…Conventional antipsychotics were consistently associated with a 20-40% relative increased risk of death when compared to atypical antipsychotics [22,26-29,31,32,56]. Absolute risks, however, varied between studies according to the method employed to control for confounding.…”

Section: Resultsmentioning

confidence: 99%

“…Absolute risks, however, varied between studies according to the method employed to control for confounding. Conventional statistical methods adjusting for measured covariates suggested an increased risk over 6 months of between 2 and 3 deaths per 100 patients treated with conventional compared to atypical antipsychotics [22,27,56] while those that used an instrumental variable analysis, to adjust for unmeasured confounding, found an increased risk of between 4 and 7 deaths per 100 patients treated over 6 months [28,29] and up to 10 deaths per 100 over 12 months [31]. Only one observational cohort study [26] and one case–control study [23] found no significant difference between the classes.…”

Section: Resultsmentioning

confidence: 99%

Choice of observational study design impacts on measurement of antipsychotic risks in the elderly: a systematic review

Pratt

Roughead

Salter

et al. 2012

BMC Med Res Methodol

View full text Add to dashboard Cite

BackgroundAntipsychotics are frequently and increasingly prescribed to treat the behavioural symptoms associated with dementia despite their modest efficacy. Evidence regarding the potential adverse events of antipsychotics is limited and little is known about the longer-term safety of these medicines in the elderly. The aim of this review was to determine the impact of the choice of observational study design and methods used to control for confounding on the measurement of antipsychotic risks in elderly patients.MethodsWe searched PUBMED and the Cochrane controlled trials register for double-blind randomised controlled trials (RCTs), meta-analyses and published observational studies of antipsychotics.ResultsForty four studies were identified for the endpoints; death, cerebrovascular events, hip fracture and pneumonia. RCTs found a 20% to 30% increased risk of death, or an absolute increase of 1extra death per 100 patients with atypical antipsychotics compared to non-use. Cohort and instrumental variable analyses estimated between 2 to 7 extra deaths per 100 patients with conventional compared to atypical antipsychotics. RCTs found a 2 to 3 times increased risk of all cerebrovascular events with atypical antipsychotics compared to placebo and no association with serious stroke that required hospitalisation. Observational studies using cohort and self-controlled case-series designs reported similar results; no association where the endpoint was stroke causing hospitalisation and a doubling of risk when minor stroke was included. No RCTs were available for the outcome of hip fracture or pneumonia. Observational studies reported a 20% to 40% increased risk of hip fracture with both antipsychotic classes compared to non-use. The risk of pneumonia was a 2 to 3 times greater with both classes compared to non-use while a self-controlled case-series study estimated a 60% increased risk. Conventional antipsychotics were associated with a 50% greater hip fracture risk than atypical antipsychotics, while the risk of pneumonia was similar between the classes.ConclusionsChoice of observational study design is critical in studying the adverse effects of antispychotics. Cohort and instrumental variable analyses gave more consistent results to clinical studies for mortality outcomes as have self-controlled case-series for the risk of cerebrovascular events and stroke. Observational evidence has highlighted the potential for antipsychotics to be associated with serious adverse events that were not reported in RCTs including hip fracture and pneumonia. Good quality observational studies are required, that employ appropriate study designs that are robust towards unmeasured confounding, to confirm the potential excess risk of hip fracture and pneumonia with antipsychotics.

show abstract

“…10,13,31,34,[36][37][38]41,42,47,52 In all nine of these studies, users of conventional antipsychotics had a higher risk of mortality than users of atypical antipsychotics (see Table 2). 10,13,31,34,[36][37][38]41,42,47,52 In all nine of these studies, users of conventional antipsychotics had a higher risk of mortality than users of atypical antipsychotics (see Table 2).…”

Section: Atypical Vs Conventional Apm and All-cause Mortalitymentioning

confidence: 99%

Intermittent antipsychotic medication and mortality in institutionalized older adults: A scoping review

Randle

Heckman

Oremus

et al. 2019

Int J Geriat Psychiatry

View full text Add to dashboard Cite

Objective/Background Antipsychotic use appears to increase mortality risk among older adults with dementia. Whether this risk is similar for regular or intermittent use is unknown. This scoping review aims to explore the temporal association between antipsychotic use and mortality risk for older institutionalized adults. Method We conducted a scoping review using Medline (PubMed), EMBASE, CINAHL, and the Cochrane libraries between October 2018 and January 2019. Results Twenty‐eight articles met review criteria. We found that different antipsychotic medications present different safety profiles. The risk of mortality was highest with conventional antipsychotic use and within 40 days of antipsychotic initiation. Conclusions Conventional antipsychotic use increases mortality for older institutionalized adults. The evidence for atypical antipsychotics is less clear. Mortality risk appears highest within 30 to 40 days of initiating antipsychotic treatment. This temporal association suggests increased mortality may actually be the result of some previously unrecognized illness, comorbidity, change in health status, or increased frailty, rather than an idiosyncrasy of the antipsychotic itself.

show abstract

Risk of Death Associated with Antipsychotic Drug Dispensing in Residential aged Care Facilities

Cited by 17 publications

References 33 publications

Association of Antipsychotic Use With Hospital Events and Mortality Among Medicare Beneficiaries Residing in Long-Term Care Facilities

Association of Antipsychotic Use With Hospital Events and Mortality Among Medicare Beneficiaries Residing in Long-Term Care Facilities

Choice of observational study design impacts on measurement of antipsychotic risks in the elderly: a systematic review

Intermittent antipsychotic medication and mortality in institutionalized older adults: A scoping review

Contact Info

Product

Resources

About