Elderly patients with dementia who are put on antipsychotic medication are more likely to be hospitalized or die within 30 days of first using the drug than those who are not put on the drugs, a new Canadian study says.

Dr. Paula Rochon of Ontario's Institute for Clinical Evaluative Sciences (ICES) led a team of colleagues who analyzed data from more than 41,000 elderly adults living with dementia and residing in either nursing homes or in the general community.

Compared to elderly dementia patients who live in the general community who were not put on antipsychotic medication:

• patients who were put on atypical, or newer, antipsychotic drugs, such as olanzapine or risperidone, were three times more likely to be hospitalized or die within 30 days of starting drug therapy.
• patients who were put on conventional, or older, antipsychotic drugs, such as haloperidol or loxaprine, were four times more likely to be hospitalized or die within 30 days.

Compared to elderly dementia patients who live in nursing homes who were not put on antipsychotic medication:

• patients put on atypical antipsychotic medication were 1.9 times more likely to be hospitalized or die within the first 30 days.
• patients put on convention antipsychotic medication were 2.4 times more likely to be hospitalized or die.

The study was published Monday in the Archives of Internal Medicine.

In their study, the researchers said that antipsychotic medication is often prescribed to dementia patients to manage their symptoms. As well, about 17 per cent of people who enter nursing homes are put on a short-term course of the drugs within 100 days of admission to ease the anxiety over their transition from home to a care facility.

"It's a double edged sword," said Rochon, a scientist at the Baycrest Geriatric Health Care System in Toronto, in a statement.

"On one hand the drug may cause serious harm to the frail elderly and on the other, they may make life easier in some very difficult situations. We need to proceed with caution even when short-term therapy is being prescribed, to ensure that the benefits of the drug outweigh the risks for the individual."

The researchers speculate that the findings may be a conservative estimate of rates of hospitalization and death because doctors choose to take patients off the medications at the first sign of side effects. As well, some patients who had serious side effects while in nursing homes may never have been brought to hospital.

"Our results exploring serious adverse events likely identify only the tip of the iceberg," the study's authors wrote.

Abstract:

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

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.