[Dysphagia] Antipsychotic Drug Use and Mortality in Older Adults with Dementia

[pleslie at pitt.edu (Leslie, Paula)]

Hi All

 

I can't remember if this has been posted or not.  It might be considered
a little tangential but I have a big interest in dementia.  Is someone
confused or dehydrated?  Is it behaviour problems or behaviour
indicating a problem?

 

I know we know this but it might be evidence to help us in some
scenarios.

 

Paula

 

Dr Paula Leslie

CertMRCSLT

Associate Professor, Communication Science and Disorders

Specialist Advisor (Swallowing Disorders) RCSLT

University of Pittsburgh

4033 Forbes Tower

Pittsburgh, PA 15260

tel: (+1) 412- 383-6748 fax: (+1) 412-383-6555

 <mailto:pleslie at pitt.edu> pleslie at pitt.edu

 <http://www.shrs.pitt.edu/> http://www.shrs.pitt.edu 

 


Antipsychotic Drug Use and Mortality in Older Adults with Dementia


 <http://www.annals.org/cgi/content/full/146/11/775#FN#FN>
<http://www.annals.org/cgi/content/full/146/11/775#FN#FN> Sudeep S.
Gill, MD, MSc; Susan E. Bronskill, PhD; Sharon-Lise T. Normand, PhD;
Geoffrey M. Anderson, MD, PhD; Kathy Sykora, MSc; Kelvin Lam, MSc; Chaim
M. Bell, MD, PhD; Philip E. Lee, MD; Hadas D. Fischer, MD; Nathan
Herrmann, MD; Jerry H. Gurwitz, MD; and Paula A. Rochon, MD, MPH 


5 June 2007 | Volume 146 Issue 11 | Pages 775-786 

Background: Antipsychotic drugs are widely used to manage behavioral and
psychological symptoms in dementia despite concerns about their safety. 

Objective: To examine the association between treatment with
antipsychotics (both conventional and atypical) and all-cause mortality.


Design: Population-based, retrospective cohort study. 

Setting: Ontario, Canada. 

Patients: Older adults with dementia who were followed between 1 April
1997 and 31 March 2003. 

Measurements: The risk for death was determined at 30, 60, 120, and 180
days after the initial dispensing of antipsychotic medication. Two
pairwise comparisons were made: atypical versus no antipsychotic use and
conventional versus atypical antipsychotic use. Groups were stratified
by place of residence (community or long-term care). Propensity score
matching was used to adjust for differences in baseline health status. 

Results: A total of 27 259 matched pairs were identified. New use of
atypical antipsychotics was associated with a statistically significant
increase in the risk for death at 30 days compared with nonuse in both
the community-dwelling cohort (adjusted hazard ratio, 1.31 [95% CI, 1.02
to 1.70]; absolute risk difference, 0.2 percentage point) and the
long-term care cohort (adjusted hazard ratio, 1.55 [CI, 1.15 to 2.07];
absolute risk difference, 1.2 percentage points). Excess risk seemed to
persist to 180 days, but unequal rates of censoring over time may have
affected these results. Relative to atypical antipsychotic use,
conventional antipsychotic use was associated with a higher risk for
death at all time points. Sensitivity analysis revealed that unmeasured
confounders that increase the risk for death could diminish or eliminate
the observed associations. 

Limitations: Information on causes of death was not available. Many
patients did not continue their initial treatments after 1 month of
therapy. Unmeasured confounders could affect associations. 

Conclusions: Atypical antipsychotic use is associated with an increased
risk for death compared with nonuse among older adults with dementia.
The risk for death may be greater with conventional antipsychotics than
with atypical antipsychotics.