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    Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults

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    Author
    Kheirbek, R.E.
    Fokar, A.
    Little, J.T.
    Date
    2019
    Journal
    The journals of gerontology. Series A, Biological sciences and medical sciences
    Publisher
    Oxford University Press
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1093/gerona/glz045
    Abstract
    BACKGROUND: Antipsychotics are prescribed to treat various symptoms in older adults, however, their safety in this context has not been fully evaluated. The objective was to evaluate mortality risks associated with off-label use of antipsychotics among older adults with no preexisting mental illness or dementia relative to those with diagnosis of dementia. METHODS: Data (2007-2015) were derived from Department of Veterans Affairs registries for 730,226 patients (?65 years) with no baseline serious mental illness, dementia). We estimated the cumulative incidence of antipsychotics prescription and 10-year all-cause mortality. The extended Cox models were used to estimate Hazard Ratios (HRs) associated with antipsychotics prescription, adjusted for time-varying covariates, dementia diagnosis, comorbidity index score, and age at time of first exposure to antipsychotics. RESULTS: The study included 98% males, 13% African Americans, and 81% Caucasian. Patients with dementia and antipsychotics had the highest risk of mortality (78.0%), followed by (73.0%) for patients with dementia alone and compared with patients without dementia or antipsychotics exposure who had the lowest mortality risk (42.0%). Exposure to typical antipsychotics was associated with (HR: 2.1, confidence interval [CI] 2.0-2.2) compared with atypical antipsychotics (HR: 1.5, CI 1.4-1.5, p = <.0001). CONCLUSION: In a large cohort of older adults, antipsychotics were associated with an increased risk of all-cause mortality. While significant increase in mortality was attributable to the diagnosis of dementia, the addition of antipsychotics resulted in added mortality risk among all patients. Antipsychotic medications should be used cautiously in all older adults, not only those with dementia.
    Keyword
    Cognition
    Drug related
    Primary care
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85074959218&doi=10.1093%2fgerona%2fglz045&partnerID=40&md5=8dd860cd68c73a5bdd4e88a680e4c4eb; http://hdl.handle.net/10713/11438
    ae974a485f413a2113503eed53cd6c53
    10.1093/gerona/glz045
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    UMB Open Access Articles 2019

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