Off-Label Use of Antipsychotics and Health Related Quality of Life in Community Living Older Adults

Abstract

To determine the relationship between off-label use of antipsychotics (AP) and health related quality of life (HRQL) in older adults. This study was based on n = 1020 community living older adults, participating in the ‘Etude sur la sante des aines’ (ESA)-Services longitudinal study (2010–2015) and covered under Quebec’s public drug insurance plan. Off-label use of AP was identified via the province of Quebec’s health administrative and pharmaceutical databases « Regie d’Assurance Maladie du Quebec » (RAMQ). Off-label use was defined by the presence of an AP and the absence, during the same one-year period, of an approved indication by Health Canada. HRQL was measured using a visual analogue scale (HRQL-VAS) and based on functional health status (HRQL-FHS). Multiple linear regressions were used to assess the association between AP use and HRQL at baseline and the change in HRQL at three years follow-up. HRQL-FHS at baseline was positively associated with off-label use of AP compared to on-label use [B = 0.26; 95% CI: 0.12; 0.40]. However, the change in HRQL-FHS was negatively associated with off-label use of AP compared to on-label use [B = −0.18; 95% CI: -0.33; −0.04], and compared to non-use [B = −0.10; 95% CI: -0.18; −0.03]. No association was observed with the HRQL-VAS. Off-label AP users reported better functional health status at baseline, reflecting lower disease severity. The decline in HRQL over the 3-year period in off-label AP use may reflect a lack of AP use efficacy in preventing health status decline.