Abstract
BackgroundThere is a high burden of antipsychotic use in residential aged care facilities (RACFs) and there is concern regarding potential inappropriate prescribing of antipsychotics in response to mild behavioural symptoms. Antipsychotic use has been associated with a higher risk of mortality in community-dwelling older adults with dementia, but few studies have examined associations upon RACF entry.AimsTo examine associations between incident antipsychotic use and risk of mortality for people with and without diagnosed dementia in RACFs.MethodsA retrospective cohort study, employing a new-user design (individuals did not receive an antipsychotic 6 months before enrolment) of 265,820 people who accessed RACFs in Australia between 1/4/2008 and 30/6/2015 was conducted. Cox regression models were used to examine adjusted associations between antipsychotic use in the first 100 days of RACF entry and mortality.ResultsIn the 100 days after entering care, 29,455 residents (11.1%) were dispensed an antipsychotic. 180,956 (68.1%) residents died [38,249 (14.4%) were related to cerebrovascular causes] over a median 2.1 years (interquartile range 1.0–3.6) follow-up. Of the residents included, 119,665 (45.0%) had a diagnosis of dementia. Incident antipsychotic use was associated with higher risk of mortality in residents with dementia (adjusted hazard ratio 1.20, 95% confidence interval 1.18–1.22) and without dementia (1.28, 1.24–1.31).ConclusionInitiation of antipsychotics after moving to RACFs is associated with a higher risk of mortality. Careful consideration of the potential benefits and harms should be given when starting a new prescription for antipsychotics for people moving to RACFs.
Highlights
Moving to residential aged care facilities (RACFs) can be a distressing time due to the major lifestyle change of moving to an unfamiliar setting, separation from family members, and potential issues regarding privacy and independence [1]
We aim to examine associations between incident antipsychotic use and risk of mortality for people with and without diagnosed dementia in RACFs in Australia
Of the residents living with dementia 18.7% (n = 22,408) received an antipsychotic compared to 4.8% (n = 7,047) of residents without dementia
Summary
Moving to residential aged care facilities (RACFs) can be a distressing time due to the major lifestyle change of moving to an unfamiliar setting, separation from family members, and potential issues regarding privacy and independence [1]. Pharmacological approaches to managing behaviours for people with dementia include the use of antipsychotics, despite limited effectiveness for this use and the potential for serious adverse events, including mortality [6] These adverse effects must be considered when determining the appropriateness of prescribing antipsychotics to residents and non-pharmacological approaches are preferred [6, 7]. There is a high burden of antipsychotic use in residential aged care facilities (RACFs) and there is concern regarding potential inappropriate prescribing of antipsychotics in response to mild behavioural symptoms. Antipsychotic use has been associated with a higher risk of mortality in community-dwelling older adults with dementia, but few studies have examined associations upon RACF entry.
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