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Risk of Adverse Outcomes for Older People with Dementia Prescribed Antipsychotic Medication: A Population Based e-Cohort Study
INTRODUCTION: Over recent years there has been growing evidence of increased risk of mortality associated with antipsychotic use in older people with dementia. Although this concern combined with limited evidence of efficacy has informed guidelines restricting antipsychotic prescription in this popu...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Healthcare
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447553/ https://www.ncbi.nlm.nih.gov/pubmed/28054240 http://dx.doi.org/10.1007/s40120-016-0060-6 |
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author | Dennis, Michael Shine, Laura John, Ann Marchant, Amanda McGregor, Joanna Lyons, Ronan A. Brophy, Sinead |
author_facet | Dennis, Michael Shine, Laura John, Ann Marchant, Amanda McGregor, Joanna Lyons, Ronan A. Brophy, Sinead |
author_sort | Dennis, Michael |
collection | PubMed |
description | INTRODUCTION: Over recent years there has been growing evidence of increased risk of mortality associated with antipsychotic use in older people with dementia. Although this concern combined with limited evidence of efficacy has informed guidelines restricting antipsychotic prescription in this population, the use of antipsycotics remains common. Many published studies only report short-term outcomes, are restricted to examining mortality and stroke risk or have other limitations. The aim of this study was to assess adverse outcomes associated with the use of antipsychotics in older people living with dementia in Wales (UK). METHODS: This was a retrospective study of a population-based dementia cohort using the Welsh Secure Anonymised Information Linkage databank. The prior event rate ratio (PERR) was used to estimate the influence of exposure to antipsychotic medication on acute cardiac events, venous thromboembolism, stroke and hip fracture, and adjusted Cox proportional hazard models were used to compare all-cause mortality. RESULTS: A total of 10,339 people aged ≥65 years were identified with newly diagnosed dementia. After excluding those who did not meet the inclusion criteria, 9674 people remained in the main cohort of whom 3735 were exposed to antipsychotic medication. An increased risk of a venous thromboembolic episode [PERR 1.95, 95% confidence interval (CI) 1.83–2.0], stroke (PERR 1.41, 95% CI 1.4–1.46) and hip fracture (PERR 1.62, 95% CI 1.59–1.65) was associated with antipsychotic use. However, there was no long-term increased mortality in people exposed to antipsychotics (adjusted hazard ratio 1.06, 95% CI 0.99–1.13). CONCLUSIONS: The increase in adverse medical events supports guidelines restricting antipsychotic use in this population. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40120-016-0060-6) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5447553 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Springer Healthcare |
record_format | MEDLINE/PubMed |
spelling | pubmed-54475532017-06-13 Risk of Adverse Outcomes for Older People with Dementia Prescribed Antipsychotic Medication: A Population Based e-Cohort Study Dennis, Michael Shine, Laura John, Ann Marchant, Amanda McGregor, Joanna Lyons, Ronan A. Brophy, Sinead Neurol Ther Original Research INTRODUCTION: Over recent years there has been growing evidence of increased risk of mortality associated with antipsychotic use in older people with dementia. Although this concern combined with limited evidence of efficacy has informed guidelines restricting antipsychotic prescription in this population, the use of antipsycotics remains common. Many published studies only report short-term outcomes, are restricted to examining mortality and stroke risk or have other limitations. The aim of this study was to assess adverse outcomes associated with the use of antipsychotics in older people living with dementia in Wales (UK). METHODS: This was a retrospective study of a population-based dementia cohort using the Welsh Secure Anonymised Information Linkage databank. The prior event rate ratio (PERR) was used to estimate the influence of exposure to antipsychotic medication on acute cardiac events, venous thromboembolism, stroke and hip fracture, and adjusted Cox proportional hazard models were used to compare all-cause mortality. RESULTS: A total of 10,339 people aged ≥65 years were identified with newly diagnosed dementia. After excluding those who did not meet the inclusion criteria, 9674 people remained in the main cohort of whom 3735 were exposed to antipsychotic medication. An increased risk of a venous thromboembolic episode [PERR 1.95, 95% confidence interval (CI) 1.83–2.0], stroke (PERR 1.41, 95% CI 1.4–1.46) and hip fracture (PERR 1.62, 95% CI 1.59–1.65) was associated with antipsychotic use. However, there was no long-term increased mortality in people exposed to antipsychotics (adjusted hazard ratio 1.06, 95% CI 0.99–1.13). CONCLUSIONS: The increase in adverse medical events supports guidelines restricting antipsychotic use in this population. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40120-016-0060-6) contains supplementary material, which is available to authorized users. Springer Healthcare 2017-01-04 /pmc/articles/PMC5447553/ /pubmed/28054240 http://dx.doi.org/10.1007/s40120-016-0060-6 Text en © The Author(s) 2017 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Research Dennis, Michael Shine, Laura John, Ann Marchant, Amanda McGregor, Joanna Lyons, Ronan A. Brophy, Sinead Risk of Adverse Outcomes for Older People with Dementia Prescribed Antipsychotic Medication: A Population Based e-Cohort Study |
title | Risk of Adverse Outcomes for Older People with Dementia Prescribed Antipsychotic Medication: A Population Based e-Cohort Study |
title_full | Risk of Adverse Outcomes for Older People with Dementia Prescribed Antipsychotic Medication: A Population Based e-Cohort Study |
title_fullStr | Risk of Adverse Outcomes for Older People with Dementia Prescribed Antipsychotic Medication: A Population Based e-Cohort Study |
title_full_unstemmed | Risk of Adverse Outcomes for Older People with Dementia Prescribed Antipsychotic Medication: A Population Based e-Cohort Study |
title_short | Risk of Adverse Outcomes for Older People with Dementia Prescribed Antipsychotic Medication: A Population Based e-Cohort Study |
title_sort | risk of adverse outcomes for older people with dementia prescribed antipsychotic medication: a population based e-cohort study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447553/ https://www.ncbi.nlm.nih.gov/pubmed/28054240 http://dx.doi.org/10.1007/s40120-016-0060-6 |
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