BACKGROUND: 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. RESULTS: Of 10,900 patients admitted to nursing homes, atypical antipsychotics were initiated by 1942, conventional antipsychotics by 1902, antidepressants by 2169 and benzodiazepines by 4887. Compared with users of atypical antipsychotics, users of conventional antipsychotics and antidepressants had an increased risk of death (rate ratio [RR] 1.47, 95% confidence interval [CI] 1.14-1.91 for conventional antipsychotics and RR 1.20, 95% CI 0.96-1.50 for antidepressants), and an increased risk of femur fracture (RR 1.61, 95% CI 1.03-2.51 for conventional antipsychotics and RR 1.29, 95% 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). INTERPRETATION: 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.
BACKGROUND: 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. RESULTS: Of 10,900 patients admitted to nursing homes, atypical antipsychotics were initiated by 1942, conventional antipsychotics by 1902, antidepressants by 2169 and benzodiazepines by 4887. Compared with users of atypical antipsychotics, users of conventional antipsychotics and antidepressants had an increased risk of death (rate ratio [RR] 1.47, 95% confidence interval [CI] 1.14-1.91 for conventional antipsychotics and RR 1.20, 95% CI 0.96-1.50 for antidepressants), and an increased risk of femur fracture (RR 1.61, 95% CI 1.03-2.51 for conventional antipsychotics and RR 1.29, 95% 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). INTERPRETATION: 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.
Authors: Paula A Rochon; Sharon-Lise Normand; Tara Gomes; Sudeep S Gill; Geoffrey M Anderson; Magda Melo; Kathy Sykora; Lorraine Lipscombe; Chaim M Bell; Jerry H Gurwitz Journal: Arch Intern Med Date: 2008-05-26
Authors: Rosa Liperoti; Graziano Onder; Francesco Landi; Kate L Lapane; Vincent Mor; Roberto Bernabei; Giovanni Gambassi Journal: J Clin Psychiatry Date: 2009-10 Impact factor: 4.384
Authors: Sebastian Schneeweiss; Jeremy A Rassen; Robert J Glynn; Jerry Avorn; Helen Mogun; M Alan Brookhart Journal: Epidemiology Date: 2009-07 Impact factor: 4.822
Authors: Dilip V Jeste; Dan Blazer; Daniel Casey; Thomas Meeks; Carl Salzman; Lon Schneider; Pierre Tariot; Kristine Yaffe Journal: Neuropsychopharmacology Date: 2007-07-18 Impact factor: 7.853
Authors: Wilma Knol; Rob J van Marum; Paul A F Jansen; Patrick C Souverein; Alfred F A M Schobben; Antoine C G Egberts Journal: J Am Geriatr Soc Date: 2008-02-07 Impact factor: 5.562
Authors: Sudeep S Gill; Susan E Bronskill; Sharon-Lise T Normand; Geoffrey M Anderson; Kathy Sykora; Kelvin Lam; Chaim M Bell; Philip E Lee; Hadas D Fischer; Nathan Herrmann; Jerry H Gurwitz; Paula A Rochon Journal: Ann Intern Med Date: 2007-06-05 Impact factor: 25.391
Authors: Charles E Leonard; Cristin P Freeman; Craig W Newcomb; Warren B Bilker; Stephen E Kimmel; Brian L Strom; Sean Hennessy Journal: J Clin Exp Cardiolog Date: 2013
Authors: Georgia Aitken; Briony Murphy; Jennifer Pilgrim; Lyndal Bugeja; David Ranson; Joseph Elias Ibrahim Journal: Forensic Sci Med Pathol Date: 2017-01-16 Impact factor: 2.007