Long‐term outcomes of elders discharged on antipsychotics

Abstract

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

Discharge from hospital with newly administered antipsychotics after intensive care unit delirium – Incidence and contributing factors

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