Antipsychotics and mortality among elderly with dementia: a population based study in the Lazio region

Abstract

Abstract Background Most dementia patients experience one or more behavioral and psychological symptoms (BPSD) at some time during their illness, in particular in the middle and later stages. Antipsychotic drugs (AP) are often prescribed off-label for treating BPSD, despite concerns about safety and limited efficacy. The impact of AP on short- and long-term mortality has not been fully assessed. Objective To assess the association between the use of APs and short- and long-term mortality in a cohort of dementia patients aged ≥ 65 years residing in the Lazio region. Methods We use data from regional health information systems to conduct a retrospective age, gender and comorbidity matched cohort study with a 1:3 matching ratio to pair dementia patients new AP users with non-users. For the exposed participants, the index date was defined as the date of the first drug prescription; the same date was used for non-users matched subjects. Patients were enrolled on 31/12/2016 and followed-up from the index date through 2018. Four cohorts were enrolled to analyze mortality at 30, 60, 180 and 65 days from the index date. Adjusted estimates were obtained with propensity score matching using the Greedy Nearest Neighbor Matching algorithm. Results We enrolled 34,625 individuals (67% females, mean age 82 years) distributed as follows: 30 days cohort, 4321 users vs 12,960 non-users; 60 days cohort, 4202 users vs 12,606 non-users; 180 days cohort, 3641 users vs 19,923 non-users; 365 days cohort, 2618 users vs 7854 non-users. Multivariate analyses showed a statistically significant excess mortality at 60, 180, and 365 days since the first prescription (HR: 1.83, HR: 1.63, and HR: 1.62, respectively). Conclusions This study showed that antipsychotics increase short- and long-term mortality risk in older adults with dementia. The prescription of AP should be carefully evaluated and, if it is the best option for patient and caregiver, stringently monitored. Key messages Antipsychotic medication use is associated with an increased all-cause mortality in elderly with dementia. The mortality risk increases in 60 days after starting their use and remains elevated at 1 year.