Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults
JournalThe journals of gerontology. Series A, Biological sciences and medical sciences
PublisherOxford University Press
MetadataShow full item record
AbstractBACKGROUND: 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.
Identifier to cite or link to this itemhttps://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
- Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications.
- Authors: Kales HC, Valenstein M, Kim HM, McCarthy JF, Ganoczy D, Cunningham F, Blow FC
- Issue date: 2007 Oct
- All-cause mortality associated with atypical and conventional antipsychotics among nursing home residents with dementia: a retrospective cohort study.
- Authors: Liperoti R, Onder G, Landi F, Lapane KL, Mor V, Bernabei R, Gambassi G
- Issue date: 2009 Oct
- Comparative risk of harm associated with trazodone or atypical antipsychotic use in older adults with dementia: a retrospective cohort study.
- Authors: Watt JA, Gomes T, Bronskill SE, Huang A, Austin PC, Ho JM, Straus SE
- Issue date: 2018 Nov 26
- Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia.
- Authors: Declercq T, Petrovic M, Azermai M, Vander Stichele R, De Sutter AI, van Driel ML, Christiaens T
- Issue date: 2013 Mar 28
- Reducing Off-Label Antipsychotic Use in Older Community-Dwelling Adults With Dementia: A Narrative Review.
- Authors: Bain KT, Schwartz EJ, Chan-Ting R
- Issue date: 2017 Jul 1