Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults

Raya Elfadel Kheirbek, Ali Fokar, John T. Little, Marshall Balish, Nawar M. Shara, Malaz A. Boustani, Maria Llorente

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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 = <.0001). 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.

Original languageEnglish (US)
Pages (from-to)1916-1921
Number of pages6
JournalThe journals of gerontology. Series A, Biological sciences and medical sciences
Volume74
Issue number12
DOIs
StatePublished - Nov 13 2019

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Independent Living
Antipsychotic Agents
Dementia
Mortality
Prescriptions
Confidence Intervals
Off-Label Use
Preexisting Condition Coverage
Veterans
Proportional Hazards Models
African Americans
Registries
Comorbidity

Keywords

  • Cognition
  • Drug related
  • Primary care

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology

Cite this

Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults. / Kheirbek, Raya Elfadel; Fokar, Ali; Little, John T.; Balish, Marshall; Shara, Nawar M.; Boustani, Malaz A.; Llorente, Maria.

In: The journals of gerontology. Series A, Biological sciences and medical sciences, Vol. 74, No. 12, 13.11.2019, p. 1916-1921.

Research output: Contribution to journalArticle

Kheirbek, Raya Elfadel ; Fokar, Ali ; Little, John T. ; Balish, Marshall ; Shara, Nawar M. ; Boustani, Malaz A. ; Llorente, Maria. / Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults. In: The journals of gerontology. Series A, Biological sciences and medical sciences. 2019 ; Vol. 74, No. 12. pp. 1916-1921.
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AU - Kheirbek, Raya Elfadel

AU - Fokar, Ali

AU - Little, John T.

AU - Balish, Marshall

AU - Shara, Nawar M.

AU - Boustani, Malaz A.

AU - Llorente, Maria

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N2 - 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 = <.0001). 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.

AB - 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 = <.0001). 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.

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