Audrey D Zhang, Lindsay Zepel, Sandra Woolson, Katherine E M Miller, Loren J Schleiden, Megan Shepherd-Banigan, Joshua M Thorpe, Susan Nicole Hastings
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引用次数: 0
Abstract
Objectives: Adults with dementia are frequently prescribed antipsychotic medications despite concerns that risks outweigh benefits. Understanding conditions where antipsychotics are initially prescribed, such as hospitalization, may offer insights into reducing inappropriate use.
Design, setting, participants: Retrospective cohort study of community-dwelling veterans with dementia aged ≥68 with VA hospitalizations in 2014, using Veterans Health Administration (VA) and Medicare data.
Measurements: The primary outcome was new outpatient antipsychotic prescription at hospital discharge. We used generalized estimating equations to study associations between antipsychotic initiation and patient, hospitalization, and facility characteristics. Among veterans with antipsychotic initiation, we used a cumulative incidence function to evaluate discontinuation in the year following hospitalization, accounting for competing risks.
Results: 4,719 community-dwelling veterans with dementia had VA hospitalizations in 2014; 264 (5.6%) filled new antipsychotic prescriptions at discharge. Antipsychotic initiation was associated with discharge unit (surgical vs medical, OR 0.41, 95% CI 0.19-0.87; psychiatric vs medical, OR 6.58, 95% CI 4.48-9.67), length of stay (OR 1.03/day, 95% CI 1.02-1.05), and delirium diagnosis (OR 2.61, 95% CI 1.78-3.83), but not demographic or facility characteristics. Among veterans with antipsychotic initiation, the 1-year cumulative incidence of discontinuation was 18.2% (n = 47); 15.9% (n = 42) of those who were alive and not censored remained on antipsychotics at 1 year.
Conclusions: Antipsychotic initiation at hospital discharge was uncommon among community-dwelling veterans with dementia; however, once initiated, antipsychotic persistence at 1 year was common among those who remained community-dwelling. Hospitalization is a contributor to potentially-inappropriate medications in the community, suggesting an opportunity for medication review after hospitalization.
目的：尽管人们担心抗精神病药物的风险大于益处，但患有痴呆症的成年人仍经常被处方抗精神病药物。了解最初开具抗精神病药物处方的条件（如住院）可能有助于减少不适当用药：使用退伍军人健康管理局（VA）和医疗保险计划（Medicare）的数据，对2014年在社区居住、年龄≥68岁、在退伍军人健康管理局住院治疗的痴呆症退伍军人进行回顾性队列研究：主要结果是出院时新的门诊抗精神病药物处方。我们使用广义估计方程来研究抗精神病药物的使用与患者、住院和医疗机构特征之间的关联。在开始使用抗精神病药物的退伍军人中，我们使用累积发生率函数来评估住院后一年内的停药情况，并将竞争风险考虑在内：2014年，有4719名居住在社区的退伍军人患有痴呆症，其中264人（5.6%）在出院时开具了新的抗精神病药物处方。抗精神病药物的使用与出院单位（外科与内科，OR 0.41，95% CI 0.19-0.87；精神科与内科，OR 6.58，95% CI 4.48-9.67）、住院时间（OR 1.03/天，95% CI 1.02-1.05）和谵妄诊断（OR 2.61，95% CI 1.78-3.83）有关，但与人口统计或设施特征无关。在开始使用抗精神病药物的退伍军人中，1年内停药的累计发生率为18.2%（n = 47）；15.9%（n = 42）的存活且未被删减的退伍军人在1年内仍在使用抗精神病药物：结论：出院时开始服用抗精神病药物的情况在居住在社区的痴呆症退伍军人中并不常见；但是，一旦开始服用抗精神病药物，1年后仍居住在社区的退伍军人中普遍仍在服用抗精神病药物。住院治疗可能会导致患者在社区内使用不适当的药物，这也为住院后的用药复查提供了机会。
期刊介绍：
The American Journal of Geriatric Psychiatry is the leading source of information in the rapidly evolving field of geriatric psychiatry. This esteemed journal features peer-reviewed articles covering topics such as the diagnosis and classification of psychiatric disorders in older adults, epidemiological and biological correlates of mental health in the elderly, and psychopharmacology and other somatic treatments. Published twelve times a year, the journal serves as an authoritative resource for professionals in the field.
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