ANTIPSYCHOTIC REDUCTION IN LONG-TERM CARE: UNINTENDED PRESCRIBING OUTCOMES

Abstract

Introduction Antipsychotics are widely used to treat neuropsychiatric symptoms (NPS) of dementia in long-term care (LTC), despite many adverse effects. Targeted quality improvement, broader awareness of risks, and other initiatives over the last ten years have resulted in substantial reductions in antipsychotic prescribing in Canadian LTC, but concerning trends have been observed in rates of other medication use. It is not clear whether reductions in antipsychotic use are being propelled by appropriate deprescribing and care decisions or whether alternate, but as risky, drug therapies are being substituted for antipsychotics. Methods This is a retrospective cohort study examining the association between antipsychotic discontinuation and subsequent receipt of other medications that may be used to treat NPS using linked population-based health care databases held at the Institute for Clinical and Evaluative Sciences (ICES) on Ontario, Canada. Older Ontario LTC residents (>65 years) who met cohort entry criteria including at least 6-months of continuous antipsychotic use between April 1st, 2012 - March 31st, 2017 were included. Those who discontinued an antipsychotic were matched to persistent antipsychotic users and followed for up to 12-months. The primary outcome was receipt of a new medication from the following categories: opioids, antidepressants, mood stabilizers, benzodiazepines, and cannabinoids. Cox proportional hazards models were used to determine the hazard ratio (HR) and 95% confidence intervals (CI) for new use of medications for discontinuers compared to persistent users. Results Overall, antipsychotic discontinuers were less likely to start any new drug compare to persistent antipsychotic users (HR: 0.77, 95% CI 0.72-0.82, p Conclusions Preliminary results indicate that antipsychotic discontinuation in LTC is associated with increased initiation of other medications in individuals who survive up to 6 and 12-months following discontinuation. Among specific medication classes, antipsychotic discontinuation is associated with subsequent higher rates of antidepressant use . A more complete understanding of substitute medication prescribing patterns and other consequences of antipsychotic deprescribing will inform ongoing and future interventions in LTC and other settings where antipsychotic use for the treatment of NPS is common. This research was funded by: This project was supported by grants from the Clinical Teacher's Association and Department of Psychiatry at Queen's University, Ontario, Canada.