Treated Behavioral Symptoms and Mortality in Medicare Beneficiaries in Nursing Homes with Alzheimer's Disease and Related Dementias

Abstract

ADs may be reasonable pharmacological alternatives to APs in clinical management of ADRD-related behavioral symptoms. Initial treatment response may alter medication-associated mortality risk. Further study is needed to confirm findings using other data and behavioral symptom-specific instruments.

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

“…Our mortality rate and risk estimates associated with antipsychotic use are generally comparable with, or slightly higher than, those reported in previous observational studies. The relatively consistent finding that adverse events tend to emerge within 30 to 40 days of new antipsychotic use, observed in our study and elsewhere, suggests that priority be given to preventing initiation of therapy rather than withdrawing these drugs after prolonged use in those who may be experiencing some benefit . Although there may be other reasons to reduce duration of exposure to these agents such as the risk of falls, tardive dyskinesia, and adverse metabolic effects.…”

Intermittent antipsychotic medication and mortality in institutionalized older adults: A scoping review

“…Study characteristics are shown in Table 1. The majority of cohort designs included in this review analysed data from linked electronic databases, including linked pharmaceutical dispensing databases, 38 Medicare and Medicaid data linked to the Minimum Data Set data, 39 and hospital databases. 18 This methodology is common, and such sizable databases allows the assessment of confounders 28 and data collection from large representative samples.…”

“…This review found that mortality risk peaks shortly after APM initiation 14,40,45 and may offer some preliminary insight into the association between the increased mortality risk and APM use. 39 Usually, the individual perpetrating these expressions will receive an APM, and usually as a PRN, 57 in order to sedate or "calm down" the resident. 71 The effort to communicate these needs often manifests as BPSD, which often results in negative effects on other residents, staff, and the individual.…”

“…There was also indication that 11 studies did not control for survivor bias, since there was no description of the participants lost before follow-up. 33,36,37,[39][40][41][48][49][50][51][52] 4.3 | All-cause mortality…”

Is the Combination/Multi-target Therapy a New Promise for Alzheimer's Disease?

“…Evidences indicate that ADs may be reasonable pharmacological alternatives to APs in clinical management of such behavioral symptoms in AD [22]. However, there are no more detailed evidences of such combination therapy.…”