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. 2015 Mar;2(1):61-71.
doi: 10.1007/s40801-015-0013-x.

Antipsychotic Use and Risk of Nursing Home Admission Among Dual-Eligible Medicare Beneficiaries: A Propensity-Matched Study

Rajender R Aparasu  1 , Satabdi Chatterjee  2 , Hua Chen  2
Affiliations

Antipsychotic Use and Risk of Nursing Home Admission Among Dual-Eligible Medicare Beneficiaries: A Propensity-Matched Study

Rajender R Aparasu et al. Drugs Real World Outcomes. 2015 Mar.

Abstract

Background: Antipsychotic use is associated with serious adverse events in the elderly, and consequently can lead to further healthcare utilization such as nursing home admission.

Objective: To evaluate the risk of nursing home admission associated with typical versus atypical antipsychotic use among the US community-dwelling elderly population.

Methods: A retrospective cohort design was conducted using Medicare and Medicaid Analytical eXtract (MAX) data from four US states. The cohort included all dual-eligible beneficiaries (aged ≥65 years) who initiated antipsychotic treatment during July 2001-December 2003. The risk of nursing home admission during the 6-month follow-up period was evaluated using Cox proportional hazards regression model and extended Cox model stratified on matched pairs based on propensity score, using atypical agents as the reference category.

Results: The average risk of nursing home admission was similar among atypical antipsychotic users compared to typical users (hazard ratio [HR] 0.91; 95 % confidence interval [CI] 0.81-1.01]) However, the results of extended Cox regression revealed that the effect varied with time; typical users had a moderately lower risk of nursing home admission within the initial 90 days of therapy [HR 0.87; 95 % CI 0.77-0.97] but substantial risk was observed for 90-180 days of typical antipsychotic exposure [HR 1.58; 95 % CI 1.08-2.12].

Conclusion: The study found that, among elderly beneficiaries, typical antipsychotic use was associated with a time-dependent increase in risk of nursing home admission. Given the safety concerns with atypical antipsychotics and their extensive use in the elderly, there is a need to be cautious while prescribing antipsychotics in the vulnerable elderly population.

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Figures

Fig. 1
Fig. 1
Distribution of propensity scores in users of atypical and typical antipsychotics before propensity score matching
Fig. 2
Fig. 2
Distribution of propensity scores in users of atypical and typical antipsychotics after propensity score matching
Fig. 3
Fig. 3
Kaplan-Meier plot of crude association between users of typical and atypical antipsychotics and risk of nursing home admission
See this image and copyright information in PMC

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