Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults
| Autor: | Raya Kheirbek, Marshall Balish, Maria D. Llorente, Nawar Shara, Malaz Boustani, Ali Fokar, John T. Little |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
Aging Pediatrics medicine.medical_specialty medicine.drug_class Atypical antipsychotic Context (language use) 03 medical and health sciences 0302 clinical medicine Risk Factors Cause of Death medicine Risk of mortality Dementia Humans Cumulative incidence 030212 general & internal medicine Veterans Affairs Aged Retrospective Studies Veterans business.industry Hazard ratio Off-Label Use medicine.disease Comorbidity United States The Journal of Gerontology: Medical Sciences Female Independent Living Geriatrics and Gerontology business 030217 neurology & neurosurgery Antipsychotic Agents |
| Zdroj: | J Gerontol A Biol Sci Med Sci |
| Popis: | 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 = 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. |
| Databáze: | OpenAIRE |
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