Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes

Abstract

Research CMAJBackground: Despite safety-related concerns, psychotropic medications are frequently prescribed to manage behavioural symptoms in older adults, particularly those with dementia. We assessed the comparative safety of different classes of psychotropic medications used in nursing home residents. Methods:We identified a cohort of patients who were aged 65 years or older and had initiated treatment with psychotropics after admission to a nursing home in British Columbia between 1996 and 2006. We used proportional hazards models to compare rates of death and rates of hospital admissions for medical events within 180 days after treatment initiation. We used propensity-score adjustments to control for confounders. CI 0.86-1.94 for antidepressants). Users of benzodiazepines had a higher risk of death (RR 1.28, 95% CI 1.04-1.58) compared with users of atypical antipsychotics. The RR for heart failure was 1.54 (95% CI 0.89-2.67), and for pneumonia it was 0.85 (95% CI 0.56-1.31). ResultsInterpretation: Among older patients admitted to nursing homes, the risks of death and femur fracture associated with conventional antipsychotics, antidepressants and benzodiazepines are comparable to or greater than the risks associated with atypical antipsychotics. Clinicians should weigh these risks against the potential benefits when making prescribing decisions. Abstract

A multidisciplinary approach for the optimal treatment of problem behaviour in dementia

“…Daarbij vindt uitgebreid onderzoek plaats naar beïnvloedende factoren in de omgeving, de verandermogelijkheden en opvangcapaciteit van deze omgeving [6]. Behandeling van probleemgedrag bij dementerende ouderen met antipsychotica, antidepressiva en benzodiazepines heeft een beperkt positief effect en leidt bovendien tot een hoger mortaliteitsrisico [7]. Het inzetten van psychosociale interventies bij probleemgedrag zijn hierbij een eerste keus en kunnen leiden tot een significante afname van antipsychoticagebruik van 50 naar 23 % [8].…”

Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012

“…Th ese concerns include cognitive decline [89], adverse metabolic eff ects [90,91], and extrapyramidal symptoms [92]. Similarly, newer studies appear to confi rm the risk of excess mortality in antipsychotic-treated patients with dementia, although diff erent antipsychotics may have relatively diff erent risks and some other nonantipsychotic drugs may carry similar risks [93][94][95][96].…”

Effect of doll therapy in managing challenging behaviours in people with dementia: a systematic review protocol

“…Concerns with the use of these medications include the risk of mortality, 10 their side effects and their effectiveness in relieving BPSD. 1,11,12 Extra pyramidal symptoms, falls, gait disturbances, sedation, tardive dyskinesia and cerebrovascular incidents have been widely reported in literature associated with the use of antipsychotics for people with BPSD.…”