Relevance of frailty to mortality associated with the use of antipsychotics among community‐residing older adults with impaired cognition

Maxwell, Colleen J.; Campitelli, Michael A.; Hogan, David B.; Diong, Christina; Austin, Peter C.; Amuah, Joseph E.; Lapane, Kate L.; Seitz, Dallas; Gill, Sudeep S.; Gruneir, Andrea; Wodchis, Walter P.; Bronskill, Susan E.

doi:10.1002/pds.4385

Cited by 13 publications

(7 citation statements)

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“…Our findings are in agreement with previous research suggesting increased mortality in patients who have reduced cognitive function [ 3 – 5 , 21 ], and among older patients using CNSDs [ 22 , 26 , 27 ]. Nevertheless, one study found no association between mortality and BZD [ 23 ].…”

Section: Discussionsupporting

confidence: 93%

“…There are conflicting results on whether older patients exposed to CNSDs over a prolonged periods of time are at risk of increased likelihood of early death or not [ 21 – 25 ]. Some studies have found a combined effect of reduced cognitive function and increased CNSD use leading to reduced survival [ 22 , 26 , 27 ]. However, the relationship between somatic comorbidity, cognitive function and prolonged use of CNSDs is difficult to determine.…”

Section: Introductionmentioning

confidence: 99%

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The effect of cognitive function and central nervous system depressant use on mortality—A prospective observational study of previously hospitalised older patients

et al. 2022

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Background Older patients are often users of prolonged Central Nervous System Depressants (CNSD) (Z-hypnotics, benzodiazepines and opioids), which may be associated with reduced cognition. The long-term effects of CNSD use and reduced cognitive function in older patients are unclear. The aim of this study was to examine whether cognitive function and CNSD use at baseline hospitalisation were associated with all-cause mortality two years after discharge. Methods We conducted a prospective observational study, including baseline data (2017–2018) from previously hospitalised older patients (65–90 years), assessing all-cause mortality two years after discharge. We used logistic regression to assess the primary outcome, all-cause mortality two years after baseline hospitalisation. The primary predictors were cognitive function measured by The Mini Mental State Examination (MMSE) and prolonged CNSD use (continuous use ≥ 4 weeks). Adjustment variables: age, gender, education, the Hospital Anxiety and Depression Scale (HADS) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), using receiver operating characteristics (ROC) to compare the predictive power of the models. In a sub-analysis we used, the Neurobehavioural Cognitive State Examination (Cognistat) and the Clock Drawing Test. Results Two years after discharge, out of 246 baseline patients, 43 were deceased at follow-up, among these 27 (63%) were CNSD users, and 16 (36%) were non-users at baseline, (p = 0.002). In the multivariable models cognitive function (MMSE score) was a predictor of mortality (OR 0.81 (95% CI 0.69; 0.96), p = 0.014). CNSD use was associated with mortality (OR 2.71 (95% CI 1.06; 6.95), p = 0.038), with ROC AUC: 0.74–0.77 for these models. Results using Cognistat supported the findings. The Clock Drawing Test was not significant predictor of mortality. Conclusion Two years after discharge from the hospital, older patients with reduced cognitive function and CNSD use during hospital stay had higher mortality. This underlines that inappropriate (prolonged and concurrent) use of CNSDs should be avoided by older patients, particularly in patients with reduced cognitive function. Trial registration NCT03162081, 22 May 2017.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

The effect of cognitive function and central nervous system depressant use on mortality—A prospective observational study of previously hospitalised older patients

et al. 2022

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“…enhanced nutrition, cognitive stimulation, and physical activity). 17-20 Furthermore, our findings suggest that older adults may benefit from a caregiver’s support to facilitate access to videoconference-based assessments, paving the way for initiatives that increase the involvement of patients’ loved ones or volunteers. Future research should aim to implement and evaluate interventions that support older adults in being part of the digital healthcare revolution.…”

Section: Discussionmentioning

confidence: 87%

Factors associated with access to virtual care in older adults: A cross-sectional study

Liu

Goodarzi

Jones

et al. 2020

Preprint

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Background During the COVID-19 pandemic, virtual care (i.e. telephone or videoconference) has played a critical role. However, concerns were raised regarding equitable access for older adults, in particular, given potential advantages of videoconference- as opposed to telephone-based assessment. Our objective was to describe patient-specific factors associated with different modes of virtual healthcare. Methods We reviewed medical records of all patients assessed virtually in a geriatric medicine clinic in Toronto, Canada, between March 17 and July 13, 2020. We derived adjusted odds ratios (OR), risk differences (RD), and marginal and predicted probabilities, with 95% confidence intervals, from a multivariable logistic regression model, which tested the association between having a videoconference assessment (vs. a telephone assessment) and patient age, sex, ability to use a computer, education, frailty (measured on the Clinical Frailty Scale), history of cognitive impairment, and immigration history; language of assessment, and caregiver involvement in assessment. Results Our study included 330 patients (227 telephone and 103 videoconference assessments). Frailty (adjusted OR 0.62, 0.45 to 0.85; adjusted RD -0.08, -0.09 to -0.06) and absence of a caregiver (adjusted OR 0.12, 0.06 to 0.24; adjusted RD -0.35, -0.43 to -0.26) were associated with lower odds of videoconference assessment. For example, an 80-year-old woman with mild frailty who immigrated to Canada, speaks English, attained a post-secondary education, does not have cognitive impairment, and uses a computer had a 60% (39% to 80%) predicted probability of videoconference assessment if a caregiver was present compared to 15% (3% to 26%) without a caregiver. Only 32 of 98 (32.7%) patients who could independently use a computer participated in videoconference assessments. Conclusion Given the recent expansion of virtual care, we must urgently implement and evaluate strategies that optimise equitable access to videoconference-based virtual care for older adults.

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“…However, accounting for frailty when studying antipsychotic safety among elderly persons is very challenging due to issues such as unmeasured or poorly measured aspects of frailty or selective reporting of such items [42] as well as potential drug discontinuation in response to increasing levels of frailty and poorer health. An example of this concerns a recent study investigating the risk of mortality stratified by frailty levels, which reported the paradoxical finding of a higher risk for less frail persons compared to frailer ones [43].…”

Section: Discussionmentioning

confidence: 99%

All-cause mortality and antipsychotic use among elderly persons with high baseline cardiovascular and cerebrovascular risk: a multi-center retrospective cohort study in Italy

Sultana

Giorgianni

Rea

et al. 2019

Expert Opinion on Drug Metabolism & Toxicology

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Relevance of frailty to mortality associated with the use of antipsychotics among community‐residing older adults with impaired cognition

Abstract: Risk of antipsychotic-associated mortality was highest in the first month following exposure, varied significantly by client frailty, and was greater among men than among women.

Cited by 13 publications

References 52 publications

The effect of cognitive function and central nervous system depressant use on mortality—A prospective observational study of previously hospitalised older patients

The effect of cognitive function and central nervous system depressant use on mortality—A prospective observational study of previously hospitalised older patients

Factors associated with access to virtual care in older adults: A cross-sectional study

All-cause mortality and antipsychotic use among elderly persons with high baseline cardiovascular and cerebrovascular risk: a multi-center retrospective cohort study in Italy

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