Antipsychotic Medication Use Among Older Adults Following Infection-Related Hospitalization

1. In patients with newly initiated antipsychotic medications following infection-related hospitalization, discontinuation rates were lower among atypical antipsychotic users compared to haloperidol users.

Evidence Rating Level: 2 (Good)

Delirium, characterized by an acute change in mental status and cognition, presents a significant health care burden. In a hospital setting, delirium is often associated with increased mortality, functional decline, and a prolonged admission. Infection is frequently an underlying cause for delirium onset. Antipsychotic medications are commonly prescribed to manage any behavioral concerns that may arise from delirium; however, these agents are associated with adverse outcomes such as death, cardiac arrythmias, urinary dysfunction, and pneumonia. At present, there is limited information regarding factors leading to a discontinuation of antipsychotics used for delirium, which this retrospective cohort study aimed to assess. This study utilized data from the Optum’s deidentified Clinformatics Data Mart database. This paper included 5835 patients who were aged 65 and older who had a new prescription of oral antipsychotic medication within 30 days of hospital discharge. Patients who had prior use of antipsychotic medication to treat other conditions such as schizophrenia and other psychiatric disorders were excluded. The primary outcome was discontinuation of the antipsychotic medication which was defined as a gap of more than 15 days following the end of a prescription dispensing. The results of this study showed that the incidence of discontinuation within 30 days of antipsychotic initiation was 11.4% (95%CI 10.4-12.3%) among patients using atypical antipsychotics and 52.1% (95%CI 48.2-55.7%) among haloperidol users. Dementia and prolonged hospitalization were also found to be inversely associated with the discontinuation of antipsychotic medications. In conclusion, patients started on haloperidol within the hospital were more likely to discontinue this within 30 days of discharge compared to individuals started on an atypical antipsychotic. However, there are several limitations of this study that should be noted. For instance, antipsychotics started during a hospital visit may be due to reasons other than delirium onset, which was not assessed by this study. Future studies assessing this limitation can confirm antipsychotic efficacy and discontinuation rates between various medication classes.

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