Antipsychotic Medication Use Among Older Adults Following Infection-Related Hospitalization

Abstract

ImportanceThere are limited data on discontinuation rates of antipsychotic medications (APMs) used to treat delirium due to acute hospitalization in the routine care of older adults.ObjectiveTo investigate discontinuation rates and patient characteristics of APMs used to treat delirium following infection-related hospitalization among older US adults.Design, Setting, and ParticipantsThis retrospective cohort study was conducted using US claims data (Optum’s deidentified Clinformatics Data Mart database) for January 1, 2004, to May 31, 2022. Patients were aged 65 years or older without prior psychiatric disorders and had newly initiated an APM prescription within 30 days of an infection-related hospitalization. Statistical analysis was performed on December 15, 2022.ExposuresNew use (no prior use any time before cohort entry) of oral haloperidol and atypical APMs (aripiprazole, olanzapine, quetiapine, risperidone, etc).Main Outcomes and MeasuresThe primary outcome was APM discontinuation, defined as a gap of more than 15 days following the end of an APM dispensing. Survival analyses and Kaplan-Meier analyses were used.ResultsOur study population included 5835 patients. Of these individuals, 790 (13.5%) were new haloperidol users (mean [SD] age, 81.5 [6.7] years; 422 women [53.4%]) and 5045 (86.5%) were new atypical APM users (mean [SD] age, 79.8 [7.0] years; 2636 women [52.2%]). The cumulative incidence of discontinuation by 30 days after initiation was 11.4% (95% CI, 10.4%-12.3%) among atypical APM users and 52.1% (95% CI, 48.2%-55.7%) among haloperidol users (P < .001 for difference between haloperidol vs atypical APMs). We observed an increasing trend in discontinuation rates from 2004 to 2022 (5% increase [95% CI, 3%-7%] per year) for haloperidol users (adjusted hazard ratio, 1.05 [1.03-1.07]; P < .001) but not for atypical APM users (1.00 [0.99-1.01]; P = .67). Prolonged hospitalization and dementia were inversely associated with the discontinuation of haloperidol and atypical APMs.Conclusions and RelevanceThe findings of this cohort study suggest that the discontinuation rate of newly initiated APMs for delirium following infection-related hospitalization was lower in atypical APM users than in haloperidol users, with prolonged hospitalization and dementia as major associated variables. The discontinuation rate was substantially higher in recent years for haloperidol but not for atypical APMs.

Increased antipsychotic drug concentration in hospitalized patients with mental disorders following COVID-19 infection: a call for attention

“…In addition, we did not find obvious correlation between body temperature, smoking and drug concentration. This is inconsistent with previous studies that have demonstrated that drug concentration is also correlated with individual factors such as age, sex, and smoking ( 45 – 48 ). Studies have reported that polycyclic aromatic hydrocarbons in tobacco smoke can affect CYP1A2 ( 49 , 50 ) and smokers who take the same dose of clozapine orally have lower concentrations than non-smokers ( 51 – 53 ).…”

Association between social vulnerability index and admission urgency for transcatheter aortic valve replacement

“…The Optum's de-identified Clinformatics® Data Mart Database (CDM), is a de-identified, HIPAA-compliant, closed system of administrative health claims that includes claims for approximately 67 million commercial and Medicare beneficiaries from all 50 U.S. states. This database includes information on patient demographics including zip code, race and ethnicity captured administratively, medical claims, pharmacy claims, and inpatient confinement claims [ [5] , [6] , [7] , [8] ]. This study was deemed exempt from Indiana University institutional review board.…”

New antipsychotic prescription and recurrent infections among adult sepsis survivors: A population‐based cohort study

“…1 A fraction of patients are initiated on antipsychotics during critical illness (including sepsis-and infection-related hospitalizations), which are sometimes continued after discharge. 2,3 In Canada, patient and staff safety, management of agitation, sleep disorders and sedation were identified as triggers of antipsychotic treatment in such setting. 4 Antipsychotics have been associated with higher rates of infection (e.g., pneumonia).…”

“…Adult sepsis survivors present with a high risk of long‐term poor clinical outcomes, including recurrent sepsis 1 . A fraction of patients are initiated on antipsychotics during critical illness (including sepsis‐ and infection‐related hospitalizations), which are sometimes continued after discharge 2,3 . In Canada, patient and staff safety, management of agitation, sleep disorders and sedation were identified as triggers of antipsychotic treatment in such setting 4 .…”