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Antipsychotic prescription and mortality in hospitalized older persons
Author(s) -
Chiesa Deborah,
Marengoni Alessandra,
Nobili Alessandro,
Tettamanti Mauro,
Pasina Luca,
Franchi Carlotta,
Djade Codjo D.,
Corrao Salvatore,
Salerno Francesco,
Marcucci Maura,
Romanelli Giuseppe,
Mannucci Pier Mannuccio
Publication year - 2017
Publication title -
psychogeriatrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.647
H-Index - 32
eISSN - 1479-8301
pISSN - 1346-3500
DOI - 10.1111/psyg.12263
Subject(s) - medicine , antipsychotic , medical prescription , dementia , logistic regression , comorbidity , rating scale , brief psychiatric rating scale , haloperidol , psychiatry , emergency medicine , schizophrenia (object oriented programming) , psychosis , psychology , disease , developmental psychology , pharmacology , dopamine
Background Recent scientific reports have shown that older persons treated with antipsychotics for dementia‐related behavioural symptoms have increased mortality. However, the impact of these drugs prescribed during hospitalization has rarely been assessed. We aimed to investigate whether antipsychotics are associated with an increased risk of mortality during hospitalization and at 3‐month follow‐up in elderly inpatients. Methods We analyzed data gathered during two waves (2010 and 2012) by the REPOSI ( Re gistro Po literapie S ocietà I taliana M edicina I nterna). All new prescriptions of antipsychotic drugs during hospitalization, whether maintained or discontinued at discharge, were collected, and logistic regression models were used to analyze their association with in‐hospital and 3‐month mortality. Covariates were age, sex, the S hort B lessed T est ( SBT ) score, and the C umulative I llness R ating S cale. Results Among 2703 patients included in the study, 135 (5%) received new prescriptions for antipsychotic drugs. The most frequently prescribed antipsychotic during hospitalization and eventually maintained at discharge was haloperidol (38% and 36% of cases, respectively). Patients newly prescribed with antipsychotics were older and had a higher C umulative I llness R ating S cale comorbidity index both at admission and at discharge compared to those who did not receive a prescription. Of those prescribed antipsychotics, 71% had an SBT score ≥10 (indicative of dementia), 12% had an SBT score of 5–9 (indicative of questionable dementia); and 17% had an SBT score <5 (indicative of normal cognition). In‐hospital mortality was slightly higher in patients prescribed antipsychotic drugs (14.3% vs 9.4%; P = 0.109), but in multivariate analysis only male sex, older age, and higher SBT scores were significantly related to mortality during hospitalization. At 3‐month follow‐up, only male sex, older age, and higher SBT scores were associated with mortality. Conclusion We found that the prescription of antipsychotic drugs during hospitalization was not associated with in‐hospital or follow‐up mortality. Short‐term antipsychotic prescriptions (for acutely ill patients) may have a different effect than long‐term, repeated prescriptions.