Hospitalization risk associated with typical and atypical antipsychotic use in community-dwelling elderly patients

Abstract

Background: Due to age-related changes in drug disposition and response, elderly patients are more susceptible to the adverse effects of antipsychotic medications than younger adults. However, few studies have examined the impact of typical and atypical antipsychotic use on all-cause hospitalization in the elderly population. Objective: This study compared the short-term effects of incident use of typical and atypical antipsychotic agents on the risk for hospitalization in a community-dwelling elderly population. Methods: This retrospective data analysis involved a longitudinal cohort of typical and atypical antipsychotic users and was based on data from the 1996–2004 Medical Expenditure Panel Survey. Typical antipsychotic agents included chlorpromazine, fluphenazine, haloperidol, levomepromazine, loxapine, mesoridazine, molindone, perphenazine, promazine, thioridazine, thiothixene, and trifluoperazine. Atypical antipsychotic agents included aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone. Incident cases of antipsychotic use in community-dwelling elderly (aged ≥60 years) persons were selected for the assessment of risk for all-cause hospitalization within 60 days of exposure to antipsychotics. Bivariate analyses were used to compare baseline characteristics; multivariate logistic regression was used to compare hospitalization risk among users of typicals and atypicals after controlling for age, sex, race, income, insurance coverage, perceived general health, perceived mental health, and other concurrent psychotropic use. Results: The analytical sample consisted of 124 community-dwelling elderly patients (atypicals, 75 patients; typicals, 49). A majority of the elderly study sample were women (63%), white (79%), and of middle/high income (57%). The mean (SD) age of the study sample was 74.37 (8.65) years. There were no significant differences in baseline characteristics between typical and atypical users, with the exception of perceived mental health status. After controlling for other factors, the risk for hospitalization was nearly 4-fold higher with typical antipsychotic use than atypical use (odds ratio, 3.81; 95% CI, 1.12–12.99). Conclusion: In this population of community-dwelling elderly, use of typical agents was associated with an increased risk for hospitalization compared with atypical agents.