International Psychogeriatrics

Research Article

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

Tuen-Ching Chana1a2 c1, James Ka-Hay Luka1, Yat-Fung Sheaa1a2, Ka-Hin Laua3, Felix Hon-Wai Chana1, Gabriel Ka-Kui Yua3 and Leung-Wing Chua1a2a4

a1 Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong SAR, China

a2 Division of Geriatrics, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China

a3 Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China

a4 Alzheimer's Disease Research Network, SRT Healthy Aging, The University of Hong Kong, Hong Kong SAR, China


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.

(Received May 21 2011)

(Revised June 28 2011)

(Revised July 07 2011)

(Accepted July 12 2011)

(Online publication September 09 2011)


c1 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: