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Antipsychotic Therapy and Short-term Serious Events in Older Adults With Dementia
Paula A. Rochon, MD, MPH, FRCPC;
Sharon-Lise Normand, PhD;
Tara Gomes, MHSc;
Sudeep S. Gill, MD, MSc;
Geoffrey M. Anderson, MD, PhD;
Magda Melo, MSc;
Kathy Sykora, MSc;
Lorraine Lipscombe, MD, MSc;
Chaim M. Bell, MD, PhD;
Jerry H. Gurwitz, MD
Arch Intern Med. 2008;168(10):1090-1096.
Background Antipsychotic therapy is widely used to treat behavioral problems in older adults with dementia. Cohort studies evaluating the safety of antipsychotic therapy generally focus on a single adverse event. We compared the rate of developing any serious event, a composite outcome defined as an event serious enough to lead to an acute care hospital admission or death within 30 days of initiating antipsychotic therapy, to better estimate the overall burden of short-term harm associated with these agents.
Methods In this population-based, retrospective cohort study, we identified 20 682 matched older adults with dementia living in the community and 20 559 matched individuals living in a nursing home between April 1, 1997, and March 31, 2004. Propensity-based matching was used to balance differences between the drug exposure groups in each setting. To examine the effects of antipsychotic drug use on the composite outcome of any serious event we used a conditional logistic regression model. We also estimated adjusted odds ratios using models that included all covariates with a standard difference greater than 0.10.
Results Relative to those who received no antipsychotic therapy, community-dwelling older adults newly dispensed an atypical antipsychotic therapy were 3.2 times more likely (95% confidence interval, 2.77-3.68) and those who received conventional antipsychotic therapy were 3.8 times more likely (95% confidence interval, 3.31-4.39) to develop any serious event during the 30 days of follow-up. The pattern of serious events was similar but less pronounced among older adults living in a nursing home.
Conclusions Serious events, as indicated by a hospital admission or death, are frequent following the short-term use of antipsychotic drugs in older adults with dementia. Antipsychotic drugs should be used with caution even when short-term therapy is being prescribed.
Author Affiliations: Departments of Medicine (Drs Rochon, Lipscombe, and Bell) and Health Policy, Management, and Evaluation (Drs Rochon, Anderson, and Bell), University of Toronto; Institute for Clinical Evaluative Sciences (Drs Rochon, Gill, Anderson, Lipscombe, and Bell and Mss Gomes, Melo, and Sykora); Kunin-Lunenfeld Applied Research Unit, Baycrest (Dr Rochon); Department of Medicine, Women's College Hospital (Dr Lipscombe); and Department of Medicine and Keenan Research Centre (Dr Bell), Li Ka Shing Knowledge Institute (Ms Melo), St Michael's Hospital, Toronto, Ontario, Canada; Department of Health Care Policy, Harvard Medical School, and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (Dr Normand); Queen's University, Kingston, Ontario, Canada (Dr Gill); and Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester (Dr Gurwitz).
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