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Continuous use of antipsychotics and its association with mortality and hospitalization in institutionalized Chinese older adults: an 18-month prospective cohort study

Published online by Cambridge University Press:  09 September 2011

Tuen-Ching Chan ,
James Ka-Hay Luk ,
Yat-Fung Shea ,
Ka-Hin Lau ,
Felix Hon-Wai Chan ,
Gabriel Ka-Kui Yu  and
Leung-Wing Chu
Tuen-Ching Chan*
Affiliation:
Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong SAR, China Division of Geriatrics, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
James Ka-Hay Luk
Affiliation:
Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong SAR, China
Yat-Fung Shea
Affiliation:
Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong SAR, China Division of Geriatrics, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
Ka-Hin Lau
Affiliation:
Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
Felix Hon-Wai Chan
Affiliation:
Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong SAR, China
Gabriel Ka-Kui Yu
Affiliation:
Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
Leung-Wing Chu
Affiliation:
Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong SAR, China Division of Geriatrics, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China Alzheimer's Disease Research Network, SRT Healthy Aging, The University of Hong Kong, Hong Kong SAR, China
*
Correspondence should be addressed to: Tuen-Ching Chan, The University of Hong Kong, Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China. Phone: +852 28553111; Fax: +852 28176181. Email: tuenching@yahoo.com.hk.
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Abstract

Background: Previous meta-analyses have suggested that antipsychotics are associated with increased mortality in dementia patients with behavioral and psychological symptoms (BPSD). Subsequent observational studies, however, have produced conflicting results. In view of this controversy and the lack of any suitable pharmacological alternative for BPSD, this study aimed to investigate the relationship between continuous use of antipsychotics and mortality as well as hospitalizations in Chinese older adults with BPSD residing in nursing homes.

Methods: This was a prospective cohort study conducted in nursing homes in the Central & Western and Southern Districts of Hong Kong from July 2009 to December 2010. Older adults were stratified into the exposed group (current users of antipsychotics) and control group (non-users). Demographics, comorbidity according to the Charlson Comorbidity Index (CCI), Barthel Index (BI(20)), Abbreviated Mental Test (AMT), and vaccination status for pandemic Influenza A (H1N1) 2009, seasonal influenza and pneumococcus were collected at baseline. Subjects were followed up at 18 months. All-cause mortality and all-cause hospitalizations were recorded.

Results: 599 older adults with dementia from nine nursing homes were recruited. The 18-month mortality rate for the exposed group was 24.1% while that for control group was 27.5% (P = 0.38). The exposed group also had a lower median rate of hospitalizations (56 (0–111) per 1000 person-months vs 111 (0–222) per 1000 person-months, median (interquartile range), p<0.001).

Conclusions: The continuous use of antipsychotics for BPSD does not increase mortality among Chinese older adults with dementia living in nursing homes. Furthermore, our results show that the use of antipsychotics can lead to decreased hospitalizations.

Keywords

antipsychoticsmortalityhospitalizationinstitutionalized elderlynursing home
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 10 , December 2011 , pp. 1640 - 1648
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Amiel, J. M., Manguria, C. V., Ganguli, R. and Newcomer, J. W. (2008). Addressing cardiometabolic risk during treatment with antipsychotic medications. Current Opinion in Psychiatry, 21, 613–618.CrossRefGoogle ScholarPubMed
Ballard, C. et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long term follow up of a randomized placebo-controlled trial. Lancet Neurology, 2, 151–156.CrossRefGoogle Scholar
Bird, M., Jones, R. H., Korten, A. and Smithers, H. (2007). A controlled trial of a predominantly psychosocial approach to BPSD: treating causality. International Psychogeriatrics, 19, 874–891.CrossRefGoogle ScholarPubMed
Bridges-Parlet, S., Knopman, D. and Steffes, S. (1997). Withdrawal of neuroleptic medications from institutionalized dementia patients: results of a double-blind, baseline-treatment-controlled pilot study. Journal of Geriatric Psychiatry and Neurology, 10, 119–126.CrossRefGoogle ScholarPubMed
Bronskill, S. E. et al. (2009). The relationship between variations in antipsychotic prescribing across nursing homes and short-term mortality. Medical Care, 47, 1000–1008.CrossRefGoogle ScholarPubMed
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373–383.CrossRefGoogle ScholarPubMed
Chu, L. W., Pei, C. K. W., Ho, M. H. and Chan, P. T. (1995). Validation of the Abbreviated Mental Test (Hong Kong version) in the elderly medical patient. Hong Kong Medical Journal, 1, 207–211.Google Scholar
DeYoung, S., Just, G. and Harrison, R. (2002). Decreasing aggressive, agitated, or disruptive behavior: participation in a behavior management unit. Journal of Gerontological Nursing, 28, 22–31.CrossRefGoogle ScholarPubMed
Kales, H. C. et al. (2008). Mortality in people with dementia taking antipsychotics higher than in those taking other psychiatric medications. Evidence-Based Mental Health, 11, 73.Google Scholar
Liperoti, R. et al. (2009). All-cause mortality associated with atypical and conventional antipsychotics among nursing home residents with dementia: a retrospective cohort study. Journal of Clinical Psychiatry, 70, 1340–1347.CrossRefGoogle ScholarPubMed
Lonergan, E., Luxenberg, J. and Colford, J. (2002). Haloperidol for agitation in dementia. Cochrane Database Systematic. Review, 2, CD002852.Google Scholar
Luk, J. K. H., Chiu, P. K. C. and Chu, L. W. (2009) Factors affecting institutionalization in older Chinese patients after rehabilitation from acute medical problems. Archives of Gerontology and Geriatrics, 49, 110–114.CrossRefGoogle Scholar
Mahoney, F. and Barthel, D. (1965). Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 61–65.Google ScholarPubMed
Mok, W. Y. W., Chu, L. W., Chung, C. P., Chan, N. Y. and Hui, S. L. (2004). The relationship between non-cognitive symptoms and functional impairment in Alzheimer's disease. International Journal of Geriatric Psychiatry, 19, 1040–1046.CrossRefGoogle ScholarPubMed
Nordon, C. et al. (2009). Risk of death related to psychotropic drug use in older people during the European 2003 heatwave: a population-based case control study. American Journal of Geriatric Psychiatry, 17, 1059–1067.CrossRefGoogle ScholarPubMed
Raivio, M. M., Laurila, J. V., Strandberg, T. E. and Tilvis, R. S. (2007).Neither atypical nor conventional antipsychotics increase mortality or hospital admission among elderly patients with dementia: a two year prospective study. American Journal of Geriatric Psychiatry, 15, 416–424.Google Scholar
Rossom, R. C., Rector, T. S., Lederle, F. and Dysken, M. W. (2010). Are all commonly prescribed anti-psychotics associated with greater mortality in elderly male veterans with dementia? Journal of the American Geriatrics Society, 58, 1027–1034.CrossRefGoogle Scholar
Schneeweiss, S. and Maclure, M. (2000). Use of comorbidity scores for control of confounding in studies using administrative databases. International Journal of Epidemiology, 29, 891–898.CrossRefGoogle ScholarPubMed
Schneider, L. S., Pollock, V. E. and Lyness, S. A. (1990). A meta-analysis of controlled trials of neuroleptic treatment in dementia. Journal of the American Geriatrics Society, 38, 553–563.CrossRefGoogle ScholarPubMed
Schneider, L. S., Dagerman, K. S. and Insel, P. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA, 15, 1934–1943.CrossRefGoogle Scholar
Sicouri, S. and Antzelevitch, C. (2008). Sudden cardiac death secondary to antidepressants and antipsychotics drug. Expert Opinion on Drug Safety, 7, 181–194.CrossRefGoogle Scholar
Simoni-Wastila, L., Ryder, P. T., Qian, J., Zuckerman, I. H., Shaffer, T. and Zhao, L. (2009). Association of antipsychotic use with hospital events and mortality among medicare beneficiaries residing in long term care facilities. American Journal of Geriatric Psychiatry, 17, 417–427.CrossRefGoogle ScholarPubMed
Tang, M. et al. (2010). Utilization of emergency room and hospitalization by Chinese nursing home residents: a cross-sectional study. Journal of the American Medical Directors Association, 11, 325–332.CrossRefGoogle ScholarPubMed
Testad, I., Aasland, A. M. and Aarsland, D. (2007). Prevalence and correlates of disruptive behavior in patients in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 22, 916–921.CrossRefGoogle ScholarPubMed
Tondi, L., Ribani, L., Bottazzi, M., Viscomi, G. and Vulcano, V. (2007). Validation therapy (VT) in nursing homes: a case-control study. Archives of Gerontological Geriatrics, 44, 407–411.CrossRefGoogle ScholarPubMed
Torres Moreno, B. and Fernandez Duque, O. (2010). Barthel and Charlson indexes for the prognosis of mortality and institutionalization in hospitalized geriatric patients. Revista Española de Geriatría y Gerontología, 45, 111–116.Google Scholar
Trifiro, G., Verhamme, K. M. C., Ziere, G., Caputi, A. P., Stricker, B. H. and Sturkenboom, C. J. (2007). All-cause mortality associated with atypical and typical antipsychotics in demented outpatients. Pharmacoepidemiology and Drug Safety, 16, 538–544.Google Scholar
van Reekum, R. et al. (2002). A randomized, placebo-controlled trial of the discontinuation of long-term antipsychotics in dementia. International Psychogeriatrics, 14, 197–210.CrossRefGoogle ScholarPubMed
Wang, P. S. et al. (2005). Risk of death in elderly users of conventional vs. atypical antipsychotic medications. New England Journal of Medicine, 22, 2335–2341.CrossRefGoogle Scholar
Zuidema, S. U., Derken, E., Verhey, F. R. and Koopmans, R. T. (2007). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632–638.CrossRefGoogle Scholar