Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Feb;64(2):299-305.
doi: 10.1111/jgs.13943.

Antipsychotic Use in Hospitalized Adults: Rates, Indications, and Predictors

Shoshana J Herzig  1   2 , Michael B Rothberg  3 , Jamey R Guess  1 , Jennifer P Stevens  2   4 , John Marshall  2   5 , Jerry H Gurwitz  6   7 , Edward R Marcantonio  1   2   8
Affiliations

Antipsychotic Use in Hospitalized Adults: Rates, Indications, and Predictors

Shoshana J Herzig et al. J Am Geriatr Soc. 2016 Feb.

Abstract

Objectives: To investigate patterns and predictors of use of antipsychotics in hospitalized adults.

Design: Retrospective cohort study.

Setting: Academic medical center.

Participants: Individuals aged 18 and older hospitalized from August 2012 to August 2013, excluding those admitted to obstetrics and gynecology or psychiatry or with a psychotic disorder.

Measurements: Use was ascertained from pharmacy charges. Potentially excessive dosing was defined using guidelines for long-term care facilities. A review of 100 records was performed to determine reasons for use.

Results: The cohort included 17,775 admissions with a median age 64; individuals could have been admitted more than once during the study period. Antipsychotics were used in 9%, 55% of which were initiations. The most common reasons for initiation were delirium (53%) and probable delirium (12%). Potentially excessive dosing occurred in 16% of admissions exposed to an antipsychotic. Of admissions with antipsychotic initiation, 26% were discharged on these medications. Characteristics associated with initiation included age 75 and older (relative risk (RR) = 1.4, 95% confidence interval (CI) = 1.2-1.7), male sex (RR = 1.2, 95% CI = 1.1-1.4), black race (RR = 0.8, 95% CI = 0.6-0.96), delirium (RR = 4.8, 95% CI = 4.2-5.7), dementia (RR = 2.1, 95% CI = 1.7-2.6), admission to a medical service (RR = 1.2, 95% CI = 1.1-1.4), intensive care unit stay (RR = 2.1, 95% CI = 1.8-2.4), and mechanical ventilation (RR = 2.0, 95% CI = 1.7-2.4). In individuals who were initiated on an antipsychotic, characteristics associated with discharge on antipsychotics were age 75 and older (RR = 0.6, 95% CI = 0.4-0.7), discharge to any location other than home (RR = 2.5, 95% CI = 1.8-3.3), and class of in-hospital antipsychotic exposure (RR = 1.6, 95% CI = 1.1-2.3 for atypical vs typical; RR = 2.7, 95% CI = 1.9-3.8 for both vs typical).

Conclusion: Antipsychotic initiation and use were common during hospitalization, most often for delirium, and individuals were frequently discharged on these medications. Several predictors of use on discharge were identified, suggesting potential targets for decision support tools that would be used to prompt consideration of ongoing necessity.

Keywords: antipsychotics; delirium; hospitalization; medication use; pharmacoepidemiology.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.

Comment in

  • Antipsychotics: Mortality Risk Themselves?
    Mayoral VF, Boas PJ, Jacinto AF. Mayoral VF, et al. J Am Geriatr Soc. 2016 Nov;64(11):2399-2400. doi: 10.1111/jgs.14477. Epub 2016 Oct 26. J Am Geriatr Soc. 2016. PMID: 27783393 No abstract available.
  • Reply to "Antipsychotics: Mortality Risk Themselves?".
    Herzig SJ, Marcantonio ER. Herzig SJ, et al. J Am Geriatr Soc. 2016 Nov;64(11):2400. doi: 10.1111/jgs.14506. Epub 2016 Oct 26. J Am Geriatr Soc. 2016. PMID: 27783402 Free PMC article. No abstract available.

References

    1. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996;275:852–857. - PubMed
    1. Inouye SK, Viscoli CM, Horwitz RI, et al. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med. 1993;119:474–481. - PubMed
    1. Pompei P, Foreman M, Rudberg MA, et al. Delirium in hospitalized older persons: outcomes and predictors. J Am Geriatr Soc. 1994;42:809–815. - PubMed
    1. Flaherty JH, Gonzales JP, Dong B. Antipsychotics in the treatment of delirium in older hospitalized adults: A systematic review. J Am Geriatr Soc. 2011;59(Suppl 2):S269–276. - PubMed
    1. Inouye SK, Marcantonio ER, Metzger ED. Doing damage in delirium: The hazards of antipsychotic treatment in elderly persons. Lancet Psychiatry. 2014;1:312–315. - PMC - PubMed

Substances