Stephanie L Harrison1,2, Janet K Sluggett3,4,5, Catherine Lang3, Craig Whitehead6, Maria Crotty6, Megan Corlis7, Steve Wesselingh8, Maria C Inacio3. 1. Registry of Senior Australians, Health Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, SA, 5000, Australia. stephanie.harrison@liverpool.ac.uk. 2. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia. stephanie.harrison@liverpool.ac.uk. 3. Registry of Senior Australians, Health Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, SA, 5000, Australia. 4. NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia. 5. Department of Rehabilitation, Aged and Extended Care, Flinders University, Rehabilitation Building, Flinders Medical Centre, Bedford Park, SA, 5042, Australia. 6. Helping Hand Aged Care, North Adelaide, SA, 5006, Australia. 7. South Australian Health and Medical Research Institute, Adelaide, SA, 5000, Australia. 8. Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, Merseyside, L7 8TX, United Kingdom.
Abstract
BACKGROUND: There is a high burden of antipsychotic use in residential aged care facilities (RACFs) and there is concern regarding potential inappropriate prescribing of antipsychotics in response to mild behavioural symptoms. Antipsychotic use has been associated with a higher risk of mortality in community-dwelling older adults with dementia, but few studies have examined associations upon RACF entry. AIMS: To examine associations between incident antipsychotic use and risk of mortality for people with and without diagnosed dementia in RACFs. METHODS: A retrospective cohort study, employing a new-user design (individuals did not receive an antipsychotic 6 months before enrolment) of 265,820 people who accessed RACFs in Australia between 1/4/2008 and 30/6/2015 was conducted. Cox regression models were used to examine adjusted associations between antipsychotic use in the first 100 days of RACF entry and mortality. RESULTS: In the 100 days after entering care, 29,455 residents (11.1%) were dispensed an antipsychotic. 180,956 (68.1%) residents died [38,249 (14.4%) were related to cerebrovascular causes] over a median 2.1 years (interquartile range 1.0-3.6) follow-up. Of the residents included, 119,665 (45.0%) had a diagnosis of dementia. Incident antipsychotic use was associated with higher risk of mortality in residents with dementia (adjusted hazard ratio 1.20, 95% confidence interval 1.18-1.22) and without dementia (1.28, 1.24-1.31). CONCLUSION: Initiation of antipsychotics after moving to RACFs is associated with a higher risk of mortality. Careful consideration of the potential benefits and harms should be given when starting a new prescription for antipsychotics for people moving to RACFs.
BACKGROUND: There is a high burden of antipsychotic use in residential aged care facilities (RACFs) and there is concern regarding potential inappropriate prescribing of antipsychotics in response to mild behavioural symptoms. Antipsychotic use has been associated with a higher risk of mortality in community-dwelling older adults with dementia, but few studies have examined associations upon RACF entry. AIMS: To examine associations between incident antipsychotic use and risk of mortality for people with and without diagnosed dementia in RACFs. METHODS: A retrospective cohort study, employing a new-user design (individuals did not receive an antipsychotic 6 months before enrolment) of 265,820 people who accessed RACFs in Australia between 1/4/2008 and 30/6/2015 was conducted. Cox regression models were used to examine adjusted associations between antipsychotic use in the first 100 days of RACF entry and mortality. RESULTS: In the 100 days after entering care, 29,455 residents (11.1%) were dispensed an antipsychotic. 180,956 (68.1%) residents died [38,249 (14.4%) were related to cerebrovascular causes] over a median 2.1 years (interquartile range 1.0-3.6) follow-up. Of the residents included, 119,665 (45.0%) had a diagnosis of dementia. Incident antipsychotic use was associated with higher risk of mortality in residents with dementia (adjusted hazard ratio 1.20, 95% confidence interval 1.18-1.22) and without dementia (1.28, 1.24-1.31). CONCLUSION: Initiation of antipsychotics after moving to RACFs is associated with a higher risk of mortality. Careful consideration of the potential benefits and harms should be given when starting a new prescription for antipsychotics for people moving to RACFs.
Entities:
Keywords:
Antipsychotics; Dementia; Mortality; Nursing homes
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