Raya Elfadel Kheirbek1,2,3, Ali Fokar1, John T Little1,4, Marshall Balish1,4, Nawar M Shara5, Malaz A Boustani6,7,8, Maria Llorente1,4. 1. Veterans Affairs Medical Center, Washington, District of Columbia. 2. George Washington University School of Medicine and Health Sciences, Washington, District of Columbia. 3. University of Maryland School of Medicine, Baltimore. 4. Georgetown University School of Medicine, Washington, District of Columbia. 5. MedStar Health Research Institute, Washington, District of Columbia. 6. Indiana University Center for Aging Research, Indianapolis. 7. Regenstrief Institute, Inc., Indianapolis, Indiana. 8. Indiana University School of Medicine, Indianapolis.
Abstract
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. Published by Oxford University Press on behalf of The Gerontological Society of America 2019.
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. Published by Oxford University Press on behalf of The Gerontological Society of America 2019.
Authors: Marc A Khoury; Mohamad-Ali Bahsoun; Ayad Fadhel; Shukrullah Shunbuli; Saanika Venkatesh; Abdollah Ghazvanchahi; Samir Mitha; Karissa Chan; Luis R Fornazzari; Nathan W Churchill; Zahinoor Ismail; David G Munoz; Tom A Schweizer; Alan R Moody; Corinne E Fischer; April Khademi Journal: Brain Sci Date: 2022-05-05
Authors: Joan Forns; Heather E Danysh; Lisa J McQuay; Mary Ellen Turner; Colleen Dempsey; Mary S Anthony; George Demos; J Bradley Layton Journal: BMC Geriatr Date: 2022-10-06 Impact factor: 4.070