Antipsychotic Drug Use and Mortality in Older Adults with Dementia

Gill, Sudeep S.; Bronskill, Susan E.; Normand, Sharon‐Lise T.; Anderson, Geoffrey M.; Sykora, Kathy; Lam, Kelvin; Bell, Chaim M.; Lee, Philip E.; Fischer, Hadas D.; Herrmann, Nathan; Gurwitz, Jerry H.; Rochon, Paula A.

doi:10.7326/0003-4819-146-11-200706050-00006

Cited by 540 publications

(491 citation statements)

References 63 publications

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“…In 2004 the NMA warned against prescription of risperidone and olanzepine for elderly patients with dementia as published data showed a three-fold increase in cerebrovascular incidents in patients prescribed risperidone and olanzepine (Schneider et al, 2005;Brodaty et al, 2003). Later, a similar increased risk of cerebrovascular incidence has been demonstrated in typical antipsychotics as in atypical antipsychotics (Gill et al, 2005;Gill et al, 2007).…”

Section: Discontinuation Of Antipsychotic Medication and Npsmentioning

confidence: 74%

“…Newer atypical antipsychotics are believed to have fewer EPS than old typical antipsychotics, but atypical antipsychotics have been found to increase the risk of death and cerebrovascular disease in patients with dementia (Schneider et al, 2005;Ballard et al, 2011a). Cohort studies published thereafter indicated that typical antipsychotics might have even higher mortality rates than atypical antipsychotics (O'Brien, 2008;Gill et al, 2005;Gill et al, 2007). There are some indications of an association between agitation, aggression and psychosis in patients with dementia, which may have encouraged the use of antipsychotic medication for other NPS than psychosis in dementia (Rapoport et al, 2001).…”

Section: Antipsychotic Medicationmentioning

confidence: 99%

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Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Bergh

Selbæk

Engedal

2008

Int J Geriat Psychiatry

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ObjectiveThe Severe Impairment Battery (SIB) is developed to test cognitive function in patients with dementia of moderate to severe degree. We have conducted a study to assess the inter‐rater reliability and the validity of the Norwegian version of SIB.MethodsThe reliability study comprised 30 patients, and the validity study 59 patients in nursing homes. We assessed Cronbach's alpha coefficient of the scale and the inter‐rater reliability for the total SIB score and its nine sub scores between two testers by means of the Spearman's correlation coefficients. In the validity study we compared the SIB scores with the scores on the Clinical Dementia Rating Scale.ResultsThe mean SIB score was 72.10 (SD 25.37). The Cronbach's alpha was 0.97, and the inter‐rater reliability of total SIB score was Spearman's rho 0.85, and ranged from 0.46 to 0.76 for the nine sub‐scores. The mean SIB score for patients with a CDR score < 2 was 84.2(13.4), whereas total scores for patients with CDR 2 and 3 were 74 (18.9) and 48.4 (33.3), respectively. A cut‐off point of 80.5 points gave the highest accuracy in discriminating between patients with CDR 2 and CDR 3, while a cut‐off point of 87.5 best discriminated between CDR < 2 and CDR 3.ConclusionThe study indicates that the Norwegian version of SIB is a reliable and valid test with which to evaluate the cognition in patients with dementia of moderate to severe degree. Copyright © 2008 John Wiley & Sons, Ltd.

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Section: Discontinuation Of Antipsychotic Medication and Npsmentioning

confidence: 74%

Section: Antipsychotic Medicationmentioning

confidence: 99%

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Bergh

Selbæk

Engedal

2008

Int J Geriat Psychiatry

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“…The same research group reported an increased risk of death in the use of atypical antipsychotics compared to nonuse among dementia patients, using data including the additional year of 2003 (1997-2003) (Gill et al, 2007).…”

Section: Reports From Recent Non-experimental Studiesmentioning

confidence: 99%

The use of atypical antipsychotics in dementia: rethinking Simpson's paradox

Suh

2009

Int. Psychogeriatr.

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Higher rates of cerebrovascular adverse events (CVEs) and mortality for dementia patients taking active drugs were reported during industry-sponsored clinical trials of atypical antipsychotics for the treatment of behavioral and psychological symptoms of dementia (BPSD). Since then, the use of antipsychotics for BPSD has not been recommended on the basis of advisory warnings issued by regulatory authorities in several countries. Nevertheless, there are currently no demonstrated pharmacologic alternatives. Although early published and unpublished data indicated a risk, few subsequent publications have supported the initial finding. In order to update earlier comments published in International Psychogeriatrics (Shah and Suh, 2005), this editorial briefly introduces subsequent reports, summarizes the discrepant findings of experimental and non-experimental studies, highlights the effect of “Simpson's paradox”, which causes us to throw doubt on conclusions based on meta-analyses or pooled-analyses, explains this discrepancy in the light of current knowledge, and concludes with practical recommendations regarding the use of atypical antipsychotics in dementia.

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“…The inappropriate prescribing and use of antipsychotic medication in care settings is of growing concern (Alzheimer Scotland, 2008;Brimelow and Lyons, 2009), with evidence of serious detrimental effects of their overuse on people with dementia, including decrease in cognitive function (Ballard et al, 2005) and an increase in the mortality rate (Gill et al, 2007). The All-Party Parliamentary Group on Dementia (APGD, 2008) enquiry into the use of antipsychotic medication in care homes revealed that over-prescribing is often in response to 'challenging' behaviour resulting from non-recognition by staff of their patients' needs.…”

Section: Institutional Abuse and Corruption Of Carementioning

confidence: 99%

Abusive Interactions: Research in Locked Wards for People with Dementia

Kelly¹

2010

Social Policy & Society

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Antipsychotic Drug Use and Mortality in Older Adults with Dementia

Cited by 540 publications

References 63 publications

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

The use of atypical antipsychotics in dementia: rethinking Simpson's paradox

Abusive Interactions: Research in Locked Wards for People with Dementia

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