Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-19T12:02:27.451Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of comorbidity on the risk of death associated with antipsychotic use among community-dwelling older adults

Published online by Cambridge University Press:  27 February 2012

Natasa Gisev ,
Sirpa Hartikainen ,
Timothy F. Chen ,
Mikko Korhonen  and
J. Simon Bell
Natasa Gisev*
Affiliation:
Faculty of Pharmacy, The University of Sydney, New South Wales, Australia
Sirpa Hartikainen
Affiliation:
Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
Timothy F. Chen
Affiliation:
Faculty of Pharmacy, The University of Sydney, New South Wales, Australia
Mikko Korhonen
Affiliation:
Leppävirta Health Centre, Leppävirta, Finland
J. Simon Bell
Affiliation:
Faculty of Pharmacy, The University of Sydney, New South Wales, Australia Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
*
Correspondence should be addressed to: Natasa Gisev, Faculty of Pharmacy, Pharmacy and Bank Building (A15), The University of Sydney, New South Wales, Australia 2006. Phone: +612 9036 7081; Fax: +612 9351 3491. Email: natasa.gisev@sydney.edu.au.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Antipsychotics are associated with adverse events and mortality among older adults with dementia. The objective of this study was to evaluate the risk of death associated with antipsychotic use among community-dwelling older adults with a range of comorbidities.

Methods: This was a population-based cohort study of all 2,224 residents of Leppävirta, Finland, aged ≥65 years on 1 January 2000. Records of all reimbursed drug purchases were extracted from the Finnish National Prescription Register and diagnostic data were obtained from the Special Reimbursement Register. All-cause mortality was evaluated over a nine-year follow-up period. Time-dependent Cox proportional hazard models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality of antipsychotic use compared to non-use.

Results: In total, 332 residents used antipsychotics between 2000 and 2008. The unadjusted HR for risk of death associated with antipsychotic use was 2.71 (95% CI = 2.3–3.2). After adjusting for baseline age, sex, antidepressant use, and diagnostic confounders, the HR was 2.07 (95% CI = 1.73–2.47). The adjusted HR was the highest among antipsychotic users with baseline respiratory disease (HR = 2.21, 95% CI = 1.30–3.76).

Conclusions: The increased risk of death associated with antipsychotic use was similar across diagnostic categories, the highest being among those with baseline respiratory disease. However, the results should be interpreted with caution, as the overall sample size of antipsychotic users was small. As in other observational studies, residual confounding may account for the higher mortality observed among antipsychotic users. Further research is needed to confirm these findings.

Keywords

antipsychotic agentsmortalityagedpharmacoepidemiologyrespiratory tract diseases
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 7 , July 2012 , pp. 1058 - 1064
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aparasu, R. R., Jano, E., Johnson, M. L. and Chen, H. (2008). Hospitalization risk associated with typical and atypical antipsychotic use in community-dwelling elderly patients. American Journal of Geriatric Pharmacotherapy, 6, 198–204.CrossRefGoogle ScholarPubMed
Ballard, C. and Corbett, A. (2010). Management of neuropsychiatric symptoms in people with dementia. CNS Drugs, 24, 729–739.Google ScholarPubMed
Brunnström, H. R. and Englund, E. M. (2009). Cause of death in patients with dementia disorders. European Journal of Neurology, 16, 488–492.CrossRefGoogle ScholarPubMed
Chahine, L. M., Acar, D. and Chemali, Z. (2010). The elderly safety imperative and antipsychotic usage. Harvard Review of Psychiatry, 18, 158–172.CrossRefGoogle ScholarPubMed
Choi, H. K., Hernán, M. A., Seeger, J. D., Robins, J. M. and Wolfe, F. (2002). Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet, 359, 1173–1177.CrossRefGoogle ScholarPubMed
Furu, K., Wettermark, B., Andersen, M., Martikainen, J. E., Almarsdottir, A. B. and Sørensen, H. T. (2010). The Nordic countries as a cohort for pharmacoepidemiological research. Basic and Clinical Pharmacology and Toxicology, 106, 86–94.CrossRefGoogle ScholarPubMed
Gill, S. S. et al. (2007). Antipsychotic drug use and mortality in older adults with dementia. Annals of Internal Medicine, 146, 775–786.CrossRefGoogle ScholarPubMed
Gisev, N., Hartikainen, S., Chen, T. F., Korhonen, M. and Bell, J. S. (2011). Mortality associated with benzodiazepines and benzodiazepine-related drugs among community-dwelling older people in Finland: a population-based retrospective cohort study. Canadian Journal of Psychiatry, 56, 377–381.CrossRefGoogle ScholarPubMed
Guthrie, B., Clark, S. A. and McCowan, C. (2010). The burden of psychotropic drug prescribing in people with dementia: a population database study. Age and Ageing, 39, 637–642.CrossRefGoogle Scholar
Haukka, J., Suvisaari, J., Tuulio-Henriksson, A. and Lönnqvist, J. (2007). High concordance between self-reported medication and official prescription database information. European Journal of Clinical Pharmacology, 63, 1069–1074.CrossRefGoogle ScholarPubMed
Jabeen, S., Polli, S. I. and Gerber, D. R. (2006). Acute respiratory failure with a single dose of quetiapine fumerate. Annals of Pharmacotherapy, 40, 559–562.CrossRefGoogle Scholar
Jackson, M. L. et al. (2004). The burden of community-acquired pneumonia in seniors: results of a population-based study. Clinical Infectious Diseases, 39, 1642–1650.CrossRefGoogle ScholarPubMed
Joseph, K. S. (1997). Asthma mortality and antipsychotic or sedative use. What is the link? Drug Safety, 16, 351–354.CrossRefGoogle ScholarPubMed
Knol, W., van Marum, R. J., Jansen, P. A. F., Souverein, P. C., Schobben, A. F. A. M. and Egberts, A. C. G. (2008). Antipsychotic drug use and risk of pneumonia in elderly people. Journal of the American Geriatrics Society, 56, 661–666.CrossRefGoogle ScholarPubMed
Laitinen, M.-L., Bell, J. S., Lavikainen, P., Lönnroos, E., Sulkava, R. and Hartikainen, S. (2011). Nationwide study of antipsychotic use among community-dwelling older persons with Alzheimer's disease in Finland. International Psychogeriatrics, 23, 1623–1631.CrossRefGoogle Scholar
Leslie, D. L., Mohamed, S. and Rosenheck, R. A. (2009). Off-label use of antipsychotic medications in the Department of Veterans Affairs health care system. Psychiatric Services, 60, 1175–1181.CrossRefGoogle ScholarPubMed
Leveille, S. G. et al. (2009). Chronic musculoskeletal pain and the occurance of falls in an older population. JAMA, 302, 2214–2221.CrossRefGoogle Scholar
Musicco, M. et al. (2011). Association between prescription of conventional or atypical antipsychotic drugs and mortality in older persons with Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 31, 218–224.CrossRefGoogle ScholarPubMed
Pratt, N., Roughead, E. E., Ramsay, E., Salter, A. and Ryan, P. (2011). Risk of hospitalization for hip fracture and pneumonia associated with antipsychotic prescribing in the elderly: a self-controlled case-series analysis in an Australian health care claims database. Drug Safety, 34, 567–575.CrossRefGoogle Scholar
Raivio, M. M., Laurila, J. V., Strandberg, T. E., Tilvis, R. S. and Pitkälä, K. H. (2007). Neither atypical nor conventional antipsychotics increase mortality or hospital admissions among elderly patients with dementia: a two-year prospective study. American Journal of Geriatric Psychiatry, 15, 416–424.CrossRefGoogle ScholarPubMed
Ray, W. A., Chung, C. P., Murray, K. T., Hall, K. and Stein, C. M. (2009). Atypical antipsychotic drugs and the risk of sudden cardiac death. New England Journal of Medicine, 360, 225–235.CrossRefGoogle ScholarPubMed
Rikala, M., Hartikainen, S., Sulkava, R. and Korhonen, M. J. (2010). Validity of the Finnish Prescription Register for measuring psychotropic drug exposures among elderly Finns: a population-based intervention study. Drugs and Aging, 27, 337–349.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, 294, 1934–1943.CrossRefGoogle ScholarPubMed
Setoguchi, S., Wang, P. S., Brookhart, M. A., Canning, C. F., Kaci, L. and Schneeweiss, S. (2008). Potential causes of higher mortality in elderly users of conventional and atypical antipsychotic medications. Journal of the American Geriatrics Society, 56, 1644–1650.CrossRefGoogle ScholarPubMed
Strandberg, T. E., Pitkala, K. H. and Tilvis, R. S. (2009). Predictors of mortality in home-dwelling patients with cardiovascular disease aged 75 and older. Journal of the American Geriatrics Society, 57, 279–284.CrossRefGoogle Scholar
Vigen, C. L. P. et al. (2011). Cognitive effects of atypical antipsychotic medications in patients with Alzheimer's disease: outcomes from CATIE-AD. American Journal of Psychiatry, 168, 831–839.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, 353, 2335–2341.CrossRefGoogle ScholarPubMed
WHO Collaborating Centre for Drugs Statistics Methodology (2010). ATC/DDD Index 2011. Oslo, Norway: Norweigan Institute of Public Health. Available at: http://www.whocc.no/atc_ddd_index/. Last accessed 31 August 2011.Google Scholar