Risk of Adverse Outcomes for Older People with Dementia Prescribed Antipsychotic Medication: A Population Based e-Cohort Study
| Autor: | Michael Dennis, Joanna McGregor, Ann John, Sinead Brophy, Laura Shine, Ronan A Lyons, Amanda Marchant |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Neurology Adverse outcomes medicine.medical_treatment Population 03 medical and health sciences 0302 clinical medicine medicine Dementia 030212 general & internal medicine Medical prescription Mortality Psychiatry education Antipsychotic Antipsychotic medication Original Research education.field_of_study business.industry medicine.disease 3. Good health Neurology (clinical) Older people business 030217 neurology & neurosurgery Cohort study |
| Zdroj: | Neurology and Therapy |
| Popis: | Introduction Over recent years there has been growing evidence of increased risk of mortality associated with antipsychotic use in older people with dementia. Although this concern combined with limited evidence of efficacy has informed guidelines restricting antipsychotic prescription in this population, the use of antipsycotics remains common. Many published studies only report short-term outcomes, are restricted to examining mortality and stroke risk or have other limitations. The aim of this study was to assess adverse outcomes associated with the use of antipsychotics in older people living with dementia in Wales (UK). Methods This was a retrospective study of a population-based dementia cohort using the Welsh Secure Anonymised Information Linkage databank. The prior event rate ratio (PERR) was used to estimate the influence of exposure to antipsychotic medication on acute cardiac events, venous thromboembolism, stroke and hip fracture, and adjusted Cox proportional hazard models were used to compare all-cause mortality. Results A total of 10,339 people aged ≥65 years were identified with newly diagnosed dementia. After excluding those who did not meet the inclusion criteria, 9674 people remained in the main cohort of whom 3735 were exposed to antipsychotic medication. An increased risk of a venous thromboembolic episode [PERR 1.95, 95% confidence interval (CI) 1.83–2.0], stroke (PERR 1.41, 95% CI 1.4–1.46) and hip fracture (PERR 1.62, 95% CI 1.59–1.65) was associated with antipsychotic use. However, there was no long-term increased mortality in people exposed to antipsychotics (adjusted hazard ratio 1.06, 95% CI 0.99–1.13). Conclusions The increase in adverse medical events supports guidelines restricting antipsychotic use in this population. Electronic supplementary material The online version of this article (doi:10.1007/s40120-016-0060-6) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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