Skip to main content
    • Aa
    • Aa

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

  • Tuen-Ching Chan (a1) (a2), James Ka-Hay Luk (a1), Yat-Fung Shea (a1) (a2), Ka-Hin Lau (a3), Felix Hon-Wai Chan (a1), Gabriel Ka-Kui Yu (a3) and Leung-Wing Chu (a1) (a2) (a4)...

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.

Corresponding author
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:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

S. Bridges-Parlet , D. Knopman and S. Steffes (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, 119126.

S. E. Bronskill (2009). The relationship between variations in antipsychotic prescribing across nursing homes and short-term mortality. Medical Care, 47, 10001008.

S. DeYoung , G. Just and R. Harrison (2002). Decreasing aggressive, agitated, or disruptive behavior: participation in a behavior management unit. Journal of Gerontological Nursing, 28, 2231.

J. K. H. Luk , P. K. C. Chiu and L. W. Chu (2009) Factors affecting institutionalization in older Chinese patients after rehabilitation from acute medical problems. Archives of Gerontology and Geriatrics, 49, 110114.

W. Y. W. Mok , L. W. Chu , C. P. Chung , N. Y. Chan and S. L. Hui (2004). The relationship between non-cognitive symptoms and functional impairment in Alzheimer's disease. International Journal of Geriatric Psychiatry, 19, 10401046.

M. M. Raivio , J. V. Laurila , T. E. Strandberg and R. S. Tilvis (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, 416424.

R. C. Rossom , T. S. Rector , F. Lederle and M. W. Dysken (2010). Are all commonly prescribed anti-psychotics associated with greater mortality in elderly male veterans with dementia? Journal of the American Geriatrics Society, 58, 10271034.

S. Schneeweiss and M. Maclure (2000). Use of comorbidity scores for control of confounding in studies using administrative databases. International Journal of Epidemiology, 29, 891898.

L. S. Schneider , V. E. Pollock and S. A. Lyness (1990). A meta-analysis of controlled trials of neuroleptic treatment in dementia. Journal of the American Geriatrics Society, 38, 553563.

S. Sicouri and C. Antzelevitch (2008). Sudden cardiac death secondary to antidepressants and antipsychotics drug. Expert Opinion on Drug Safety, 7, 181194.

L. Simoni-Wastila , P. T. Ryder , J. Qian , I. H. Zuckerman , T. Shaffer and L. Zhao (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, 417427.

L. Tondi , L. Ribani , M. Bottazzi , G. Viscomi and V. Vulcano (2007). Validation therapy (VT) in nursing homes: a case-control study. Archives of Gerontological Geriatrics, 44, 407411.

G. Trifiro , K. M. C. Verhamme , G. Ziere , A. P. Caputi , B. H. Stricker and C. J. Sturkenboom (2007). All-cause mortality associated with atypical and typical antipsychotics in demented outpatients. Pharmacoepidemiology and Drug Safety, 16, 538544.

S. U. Zuidema , E. Derken , F. R. Verhey and R. T. Koopmans (2007). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632638.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 11
Total number of PDF views: 19 *
Loading metrics...

Abstract views

Total abstract views: 149 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 26th May 2017. This data will be updated every 24 hours.