Comparative safety of antipsychotic medications in nursing home residents

Journal of the American Geriatrics Society

Volumn 60, Issue 3, 2012, Pages 420-429

  Huybrechts, Krista F ^a   Schneeweiss, Sebastian ^a   Gerhard, Tobias ^b   Olfson, Mark ^c   Avorn, Jerry ^a   Levin, Raisa ^a   Lucas, Judith A ^b   Crystal, Stephen ^b  

^a BRIGHAM AND WOMEN S HOSPITAL   (United States)

^b RUTGERS UNIVERSITY   (United States)

^c New York Presbyterian Morgan Stanley Children's Hospital   (United States)

Author keywords

antipsychotics; dementia; nursing homes; safety

Indexed keywords

ARIPIPRAZOLE; ATYPICAL ANTIPSYCHOTIC AGENT; CHLORPROMAZINE; FLUPHENAZINE; HALOPERIDOL; NEUROLEPTIC AGENT; OLANZAPINE; PERPHENAZINE; QUETIAPINE; RISPERIDONE; THIORIDAZINE; ZIPRASIDONE;

AGED; ARTICLE; BACTERIAL INFECTION; DOSE RESPONSE; DRUG SAFETY; FEMALE; HEART INFARCTION; HIP FRACTURE; HOSPITALIZATION; HUMAN; MAJOR CLINICAL STUDY; MALE; NURSING HOME PATIENT; PNEUMONIA; RISK ASSESSMENT; STROKE; TRANSIENT ISCHEMIC ATTACK;

AGED; AGED, 80 AND OVER; ANTIPSYCHOTIC AGENTS; COHORT STUDIES; FEMALE; HUMANS; MALE; MEDICAID; MEDICARE; NURSING HOMES; PATIENT SAFETY; PROPORTIONAL HAZARDS MODELS; RISK ASSESSMENT; RISK FACTORS; UNITED STATES;

EID: 84858343138     PISSN: 00028614     EISSN: 15325415     Source Type: Journal    
DOI: 10.1111/j.1532-5415.2011.03853.x     Document Type: Article

References (44)

1. Beers M, Avorn J, Soumerai S, et al. Psychoactive medication use in intermediate-care facility residents. JAMA 1988; 260: 3016-3020.
2. Ray WA, Federspiel CF, Schaffner W,. A study of antipsychotic drug use in nursing homes: Epidemiologic evidence suggesting misuse. Am J Public Health 1980; 70: 485-491.
3. Liperoti R, Mor V, Lapane KL, et al. The use of atypical antipsychotics in nursing homes. J Clin Psychiatry 2003; 64: 1106-1112.
4. Briesacher BA, Limcangco MR, Simoni-Wastila L, et al. The quality of antipsychotic drug prescribing in nursing homes. Arch Intern Med 2005; 165: 1280-1285.
5. Bronskill SE, Anderson GM, Sykora K, et al. Neuroleptic drug therapy in older adults newly admitted to nursing homes: Incidence, dose, and specialist contact. J Am Geriatr Soc 2004; 52: 749-755.
6. Rochon PA, Stukel TA, Bronskill SE, et al. Variation in nursing home antipsychotic prescribing rates. Arch Intern Med 2007; 167: 676-683.
7. Chen Y, Briesacher B, Field T, et al. Unexplained variation across US nursing homes in antipsychotic prescribing rates. Arch Intern Med 2010; 170: 89-95.
8. Jeste DV, Blazer D, Casey D, et al. ACNP White Paper: Update on use of antipsychotic drugs in elderly persons with dementia. Neuropsychopharmacology 2007; 33: 957-970.
9. FDA Public Health Advisory: Deaths with antipsychotics in elderly patients with behavioral disturbances [on-line]. Available at Accessed May 3, 2010.
10. Schneider LS, Tariot PN, Dagerman KS, et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. N Engl J Med 2006; 355: 1525-1538.
11. Vigen C, Mack W, Keefe R, et al. Cognitive effects of atypical antipsychotic medications in patients with Alzheimer's disease: Outcomes from CATIE-AD. Am J Psychiatry 2011; 168: 831-839.
12. FDA: Information for healthcare professionals-Antipsychotics [on-line]. Available at Accessed May 3, 2010.
13. Wang PS, Schneeweiss S, Avorn J, et al. Risk of death in elderly users of conventional vs atypical antipsychotic medications. N Engl J Med 2005; 353: 2335-2341.
14. Schneeweiss S, Setoguchi S, Brookhart A, et al. Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients. Can Med Assoc J 2007; 176: 627-632.
15. Gill SS, Bronskill SE, Normand SL, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med 2007; 146: 775-786.
16. Wang P, Brookhart M, Setoguchi S, et al. Psychotropic medication use for behavioral symptoms of dementia. Curr Neurol Neurosci Rep 2006; 6: 490-495.
17. Trifiro G, Spina E, Gambassi G,. Use of antipsychotics in elderly patients with dementia: Do atypical and conventional agents have a similar safety profile? Pharmacol Res 2009; 59: 1-12.
18. Ray WA,. Evaluating medication effects outside of clinical trials: New-user designs. Am J Epidemiol 2003; 158: 915-920.
19. Schneeweiss S,. A basic study design for expedited safety signal evaluation based on electronic healthcare data. Pharmacoepidemiol Drug Saf 2010; 19: 858-868.
20. Atkins M, Burgess A, Bottomley C, et al. Chlorpromazine equivalents: A consensus of opinion for both clinical and research applications. Pscyhiatr Bull 1997; 21: 224-226.
21. Lehman A, Steinwachs D,. Translating research into practice: The Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull 1998; 24: 1-10.
22. Woods S,. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry 2003; 64: 663-667.
23. Romano P, Roos L, Jollis J,. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: Differing perspectives. J Clin Epidemiol 1993; 46: 1075-1079.
24. Schneeweiss S, Seeger JD, Maclure M, et al. Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data. Am J Epidemiol 2001; 154: 854-864.
25. Braitman LE, Rosenbaum PR,. Rare outcomes, common treatments: Analytic strategies using propensity scores. Ann Intern Med 2002; 137: 693-695.
26. Schneeweiss S, Rassen J, Glynn R, et al. High-dimensional propensity score adjustment in studies of treatment effects using health care claims data. Epidemiology 2009; 20: 512-522.
27. Rothman KJ,. No adjustments are needed for multiple comparisons. Epidemiology 1990; 1: 43-46.
28. Rothman KJ, Greenland S, Lash T,. Precision and statistics in epidemiologic studies. In:, Rothman K, Greenland S, Lash T, eds. Modern Epidemiology, 3rd Ed. Philadelphia: Lippincott Williams & Wilkins. 2008, pp 148-167.
29. Lang J, Rothman K, Cann C,. That confounded P-value. Epidemiology 1998; 9: 7-8.
30. Poole C,. Beyond the confidence interval. Am J Public Health 1987; 77: 195-199.
31. Rothman KJ,. A show of confidence. N Engl J Med 1978; 299: 1362-1363.
32. Rothman KJ,. Significance questing. Ann Intern Med 1986; 105: 445-447.
33. Stang A, Poole C, Kuss O,. The ongoing tyranny of statistical significance testing in biomedical research. Eur J Epidemiol 2010; 25: 225-230.
34. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals: Writing and editing for biomedical publication, 2010 [on-line]. Available at Accessed December 2010.
35. Setoguchi S, Wang P, Brookhart M, et al. Potential causes of higher mortality in elderly users of conventional and atypical antipsychotic medications. J Am Geriatr Soc 2008; 56: 1644-1650.
36. Knol W, van Marum R, Jansen P, et al. Antipsychotic drug use and risk of pneumonia in elderly people. J Am Geriatr Soc 2008; 56: 661-666.
37. Trifirò G, Gambassi G, Sen E, et al. Association of community-acquired pneumonia with antipsychotic drug use in elderly patients: A nested case-control study. Ann Intern Med 2010; 152: 418-425.
38. Hugenholtz G, Heerdink E, van Staa T, et al. Risk of hip/femur fractures in patients using antipsychotics. Bone 2005; 37: 864-870.
39. Liperoti R, Onder G, Lapane K, et al. Conventional or atypical antipsychotics and the risk of femur fracture among elderly patients: Results of a case-control study. J Clin Psychiatry 2007; 68: 929-934.
40. Rochon PA, Normand S-L, Gomes T, et al. Antipsychotic therapy and short-term serious events in older adults with dementia. Arch Intern Med 2008; 168: 1090-1096.
41. Bolton JM, Metge C, Lix L, et al. Fracture risk from psychotropic medications: A population-based analysis. J Clin Psychopharmacol 2008; 28: 384-391.
42. Nasrallah H,. Atypical antipsychotic-induced metabolic side effects: Insights from receptor-binding profiles. Mol Psychiatry 2008; 13: 27-35.
43. Bronskill S, Rochon P, Gill S, et al. The relationship between variations in antipsychotic prescribing across nursing homes and short-term mortality: Quality of care implications. Med Care 2009; 47: 1000-1008.
44. Rothman K, Greenland S, Lash T,. Validity in epidemiologic studies. In:, Rothman KJ, Greenland S, Lash T, eds. Modern Epidemiology, 3rd Ed. Philadelphia: Lippincott Williams & Wilkins. 2008, pp 128-147.