From hospital to community: Use of antipsychotics in hospitalized elders

Loh, Kah Poh; Ramdass, Sheryl; Garb, Jane; Brennan, Maura; Lindenauer, Peter K.; Lagu, Tara

doi:10.1002/jhm.2277

Cited by 20 publications

(34 citation statements)

References 8 publications

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“…Prior studies examining antipsychotic prescribing have focused almost exclusively on the long‐term care setting. The authors of the current study are aware of only one prior study, published as a research letter, examining antipsychotic prescribing in an acute‐care hospital that focused exclusively on hospitalized individuals aged 65 and older and found an identical 9% incidence of antipsychotic use . It similarly found that delirium was the most common reason for use.…”

Section: Discussionmentioning

confidence: 83%

Antipsychotic Use in Hospitalized Adults: Rates, Indications, and Predictors

Herzig

Rothberg

Guess

et al. 2016

J American Geriatrics Society

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Background/Objectives Although antipsychotics are used for treatment of delirium/agitation in hospitalized patients, the scope of use is unknown. We investigated patterns and predictors of use in hospitalized patients. Design Retrospective cohort study. Setting Academic medical center. Participants ≥18 years old, hospitalized 8/2012–8/2013. We excluded patients admitted to obstetrics/gynecology, psychiatry, or with a psychotic disorder. Measurements Use ascertained from pharmacy charges. Potentially excessive dosing defined using guidelines for long-term care facilities. A review of 100 records was performed to determine reasons for use. Results Our cohort included 17,775 admissions, median age 64 years. Antipsychotics were used in 9%, 55% of which were initiations. The most common reasons for initiation were delirium (53%) and probable delirium (12%). Potentially excessive dosing occurred in 16% of exposed. Among admissions with antipsychotic initiation, 26% were discharged on these medications. Characteristics associated with initiation included: age ≥ 75 years (RR 1.4 [1.2–1.7]); male sex (RR 1.2 [1.1–1.4]); black race vs. white (RR 0.8 [0.6–0.96]; delirium (RR 4.8 [4.2–5.7]); dementia (RR 2.1 [1.7–2.6]); admission to a medical service (RR 1.2 [1.1–1.4]); intensive care unit stay (RR 2.1 [1.8–2.4]); and mechanical ventilation (RR 2.0 [1.7–2.4]). Characteristics associated with discharge on antipsychotics among initiators included: age ≥ 75 years (RR 0.6 [0.4–0.7]); discharge to any location other than home (RR 2.5 [1.8–3.3]) and class of in-hospital antipsychotic exposure (RR 1.6 [1.1–2.3] for atypical vs. typical; RR 2.7 [1.9–3.8] for both vs. typical). Conclusion Antipsychotic initiation and use were common during hospitalization, most often for delirium, and patients were frequently discharged on these medications. We identified several predictors of use on discharge, suggesting potential targets for decision support tools prompting consideration of ongoing necessity.

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Section: Discussionmentioning

confidence: 83%

Antipsychotic Use in Hospitalized Adults: Rates, Indications, and Predictors

Herzig

Rothberg

Guess

et al. 2016

J American Geriatrics Society

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“…The use of APMs in hospitalized individuals without psychiatric illnesses has been investigated in only a few studies. Two single‐center studies found a similar 9% rate of off‐label APM use during nonpsychiatric hospitalization . Atypical APMs were more commonly prescribed than haloperidol and more likely to be continued at discharge .…”

Section: Discussionmentioning

confidence: 91%

Longitudinal Trends and Variation in Antipsychotic Use in Older Adults After Cardiac Surgery

Kim

Mahesri

Bateman

et al. 2018

J American Geriatrics Society

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“…For patients who were not readmitted, we were also unable to identify whether they remained on the APs initiated during their index hospitalizations. Any retrospective study is limited by the difficulty of distinguishing delirium from the behavioral and psychiatric symptoms of dementia, but we identified delirium using standard terms described in previous literature . We were unable to determine the types of delirium (hyperactive vs hypoactive) given that the documentations on behavioral symptoms were largely missing from the charts.…”

Section: Discussionmentioning

confidence: 99%

“…We documented the circumstances around APs use and identified patients who died during their hospitalizations. We identified delirium using the same terms that were described in our prior study on the same cohort of patients . We determined if patients were delirious using a predetermined algorithm (Figure ).…”

Section: Methodsmentioning

confidence: 99%

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Long‐term outcomes of elders discharged on antipsychotics

Loh

Ramdass

Garb

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Despite limited evidence of efficacy, antipsychotics (APs) are commonly used to treat delirium. There has been little research on the long‐term outcomes of patients who are started on APs in the hospital. METHODS Using a previously described retrospective cohort of 300 elders (≥65 years old) who were newly prescribed APs while hospitalized between October 1, 2012 and September 31, 2013, we examined the 1‐year outcomes of patients alive at the time of discharge. We examined number of readmissions, reasons for readmission, duration of AP therapy, use of other sedating medications, and incidence of readmission. We used the National Death Index to describe 1‐year mortality and then created a multivariable model to identify predictors of 1‐year mortality. RESULTS The 260 patients discharged alive from their index admissions had a 1‐year mortality rate of 29% (75/260). Of the 146/260 patients discharged on APs, 60 (41%) patients experienced at least 1 readmission. At the time of first readmission, 65% of patients were still taking the same APs on which they had been discharged. Eighteen patients received new APs during the readmission hospitalizations. Predictors of death at 1 year included discharge to postacute facilities after index admission (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.10‐4.73, P = 0.03) and QT interval prolongation >500 ms during index admission (OR: 3.41; 95% CI: 1.34‐8.67, P = 0.01). CONCLUSIONS Initiating an AP in the hospital is likely to result in long‐term use of these medications. Patients who received an AP during a hospitalization were at high risk of death in the following year. Journal of Hospital Medicine 2016;11:550–555. © 2016 Society of Hospital Medicine

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From hospital to community: Use of antipsychotics in hospitalized elders

Cited by 20 publications

References 8 publications

Antipsychotic Use in Hospitalized Adults: Rates, Indications, and Predictors

Antipsychotic Use in Hospitalized Adults: Rates, Indications, and Predictors

Longitudinal Trends and Variation in Antipsychotic Use in Older Adults After Cardiac Surgery

Long‐term outcomes of elders discharged on antipsychotics

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