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Patients taking antipsychotics hospitalized for 53% more days than nonusers

Marjaana Koponen

Patients with Alzheimer’s disease who initiated antipsychotics were hospitalized for 53% more days than nonusers over a 2-year period, according to results from a Finnish study published in the Journal of the American Medical Directors Association.

“It is important to assess and treat the underlying health problems triggering behavioral and psychological symptoms of dementia before initiating antipsychotic use,” Marjaana Koponen, PhD, from the Kuopio Research Center of Geriatric Care at the University of Eastern Finland, told Healio Psychiatry. “If initiation of antipsychotic use is necessary, careful and regular monitoring is needed to assess the efficacy and possible emergence of adverse effects.”

According to Koponen and colleagues, previous studies found an association between hospitalization among older patients and antipsychotic use, and they noted that all-cause hospitalization is “considered as a proxy of overall drug safety.” The researchers highlighted that antipsychotics are commonly prescribed to patients with Alzheimer’s disease, but previous research has not investigated the hospitalization risk among patients with Alzheimer’s disease nor the number of hospital days associated with antipsychotic use.

Koponen and colleagues conducted a nationwide exposure-matched cohort study to compare the accumulation of hospital days between patients with Alzheimer’s disease who did or did not initiate antipsychotics. They included 70,718 community-dwelling patients who received an incident diagnosis between 2005 and 2011. Of these, 19,909 initiated antipsychotics, and all users were matched with a nonuser based on age, sex and time since diagnosis. They measured accumulation of hospital days during a 2-year follow-up from the national hospital discharge register and determined antipsychotic use using the National Prescription Register.

The researchers reported an approximate 17-day difference in days hospitalized between the two groups — 52.5 days for antipsychotic users and 34.7 days for matched nonusers. Those who received antipsychotics had 53% more hospital days (adjusted incidence rate ratio = 1.53; 95% CI, 1.47-1.59) than those who did not. The researchers observed the strongest associations during the first 6 months of treatment, and they found that 23.8% of users and 34.1% of nonusers did not have any hospital days. “Antipsychotic users accumulated more hospital days due to dementia, mental and behavioral disorders and their caregivers’ days off,” Koponen said. “Thus, another reason for a higher accumulation of hospital days is care burden and the difficulties in treating the most severe behavioral and psychological symptoms of dementia.” – by Joe Gramigna

Disclosures: Koponen reports funding from the Academy of Finland. Please see the study for all other authors’ relevant financial disclosures.