The Impact of Antipsychotic Drugs on Long-term Care, Nursing Home Admission, and Death in Dementia Patients

Nerius, Michael; Johnell, Kristina; García-Ptacek, Sara; Eriksdotter, Maria; Haenisch, Britta; Doblhammer, Gabriele

doi:10.1093/gerona/glx239

Cited by 17 publications

(13 citation statements)

References 28 publications

(33 reference statements)

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“…People with dementia are often admitted to RACFs because of deteriorating behavioural symptoms, and this factor may contribute to increased psychotropic prescribing during the transition to residential care . Psychotropic therapy may help delay the need for residential care, but may also contribute to medicines‐related harm that increases the risk of admission . These complex relationships require further investigation.…”

Section: Discussionmentioning

confidence: 99%

The dispensing of psychotropic medicines to older people before and after they enter residential aged care

Harrison

Sluggett

Lang

et al. 2020

Medical Journal of Australia

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Section: Discussionmentioning

confidence: 99%

The dispensing of psychotropic medicines to older people before and after they enter residential aged care

Harrison

Sluggett

Lang

et al. 2020

Medical Journal of Australia

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“…Several pooled studies and meta-analyses have demonstrated increased risk of cerebrovascular events and mortality with the use of antipsychotics among persons with dementia (11,17,20,21). This was shown in older adults residing nursing homes, which might be due to advanced dementia; hence, higher baseline mortality risk (22)(23)(24)(25)(26)(27)(28).…”

mentioning

confidence: 98%

Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults

Kheirbek

Fokar

Little

et al. 2019

The Journals of Gerontology: Series A

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Background Antipsychotics are prescribed to treat various symptoms in older adults, however, their safety in this context has not been fully evaluated. The objective was to evaluate mortality risks associated with off-label use of antipsychotics among older adults with no preexisting mental illness or dementia relative to those with diagnosis of dementia. Methods Data (2007–2015) were derived from Department of Veterans Affairs registries for 730,226 patients (≥65 years) with no baseline serious mental illness, dementia). We estimated the cumulative incidence of antipsychotics prescription and 10-year all-cause mortality. The extended Cox models were used to estimate Hazard Ratios (HRs) associated with antipsychotics prescription, adjusted for time-varying covariates, dementia diagnosis, comorbidity index score, and age at time of first exposure to antipsychotics. Results The study included 98% males, 13% African Americans, and 81% Caucasian. Patients with dementia and antipsychotics had the highest risk of mortality (78.0%), followed by (73.0%) for patients with dementia alone and compared with patients without dementia or antipsychotics exposure who had the lowest mortality risk (42.0%). Exposure to typical antipsychotics was associated with (HR: 2.1, confidence interval [CI] 2.0–2.2) compared with atypical antipsychotics (HR: 1.5, CI 1.4–1.5, p = <.0001). Conclusion In a large cohort of older adults, antipsychotics were associated with an increased risk of all-cause mortality. While significant increase in mortality was attributable to the diagnosis of dementia, the addition of antipsychotics resulted in added mortality risk among all patients. Antipsychotic medications should be used cautiously in all older adults, not only those with dementia.

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“…This was accompanied by a decrease in anxiolytics and hypnotics/sedatives, but with an increase in the use of antidepressants from 43.3% in 2000 to 53.8% in 2012 [51]. In comparison, patients in our study used antipsychotics at a lower rate - 6.5% in patients with dementia who died from stroke and registered in Riksstroke compared to 8.1% who died from other causes [52].…”

Section: Discussionmentioning

confidence: 87%

Stroke as a Cause of Death in Death Certificates of Patients with Dementia: A Cohort Study from the Swedish Dementia Registry

Šubic

Županič

Euler

et al. 2018

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Introduction: Patients with dementia may be at a higher risk for death from stroke. We aimed to describe characteristics of dementia patients that died from ischemic stroke (IS) in Sweden. Methods: A retrospective longitudinal analysis of prospectively collected data of patients registered into the Swedish Dementia Registry was conducted. Data on causes of death, drugs and comorbidities were acquired from the Swedish nationwide health registers. Deaths were attributed to stroke if the death certificate contained stroke as a cause of death and the patient had a stroke registered in Riksstroke, the Swedish Stroke Register, in the year preceding death. Demographic data at the time of dementia diagnosis was compared between patients dying from IS and registered in Riksstroke, patients dying from IS without being registered in Riksstroke and those dying from other causes. Results: Out of 49823 patients diagnosed with dementia between 2007 and 2014 in primary care or specialist clinics, 14170 (28.4%) had died by the end of 2014. Of these 1180 (8.3%) had IS in their death certificate, of which 459 (38.9%) had been registered in Riksstroke. In patients who died of IS the most common type of dementia was vascular dementia while those died from other causes were most often diagnosed with Alzheimer’s dementia (AD). Patients who died from IS and were registered in Riksstroke had higher MMSE score compared to other groups. Patients who died from IS took more cardiovascular medications. There were no differences in the use of antipsychotics, antidepressants, acetylcholinesterase inhibitors, memantine, anxiolytics, or hypnotics between the groups. Conclusions: There was a relatively high number of patients who died from IS as shown in their death certificate but had not been registered in Riksstroke in the year before death. This creates concerns on the accuracy of death certificate stroke diagnoses, particularly for deaths taking place outside hospitals.

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The Impact of Antipsychotic Drugs on Long-term Care, Nursing Home Admission, and Death in Dementia Patients

Cited by 17 publications

References 28 publications

The dispensing of psychotropic medicines to older people before and after they enter residential aged care

The dispensing of psychotropic medicines to older people before and after they enter residential aged care

Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults

Stroke as a Cause of Death in Death Certificates of Patients with Dementia: A Cohort Study from the Swedish Dementia Registry

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