October 07, 2019
Older adults with Alzheimer disease (AD) who initiate treatment with antipsychotic drugs accumulate more hospital days than patients with AD who do not use antipsychotics, according to the results of a recent study.
In order to evaluate the accumulation of hospital days (a proposed proxy for overall drug safety) in patients with AD who are treated with antipsychotics, researchers conducted a study of 70,718 Finnish community dwelling adults who had received incident AD diagnosis in 2005 to 2011. Each patient who initiated antipsychotic drug treatment was paired with a noninitiator matched on age, sex, and time since diagnosis.
Over a 2-year follow-up, the accumulation of hospital days was measured using data from the national hospital discharge register. During this time, antipsychotic initiators were hospitalized, on average, for 52.5 days, while matched noninitiators were hospitalized for 34.7 days. Of those who initiated antipsychotics, 23.8% had no hospital days, while 34.1% of noninitiators had no hospital days.
Overall, initiators had 53% more hospital days than noninitiators, with the strongest associations being observed during the first 6 months of follow-up. Hospital days with primary diagnosis codes of dementia; mental and behavioral disorders; factors influencing health status; disease of the respiratory, genitourinary, and circulatory system; certain infectious and parasitic diseases; and symptoms not elsewhere classified were more common in initiators than in noninitiators.
“Part of the hospitalizations may be related to adverse effects or events. The results may also reflect difficulties in treating the most severe behavioral and psychological symptoms of dementia and the underlying health problems triggering behavioral and psychological symptoms of dementia, such as infections. These findings indicate the necessity for careful and regular monitoring of antipsychotic use to assess the response and decrease the risk of adverse events.”
Koponen M, Lavikainen P, Taipale H, et al. Accumulation of hospital days among antipsychotic initiators with alzheimer's disease [published online August 26, 2019]. JAMDA. DOI: https://doi.org/10.1016/j.jamda.2019.07.009.