A Riddle Wrapped In a Mystery Inside An Enigma: Antipsychotics and Mortality In Persons With Dementia

Jalbert, Jessica J.

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Year:: 2010
Contributor:: Jalbert, Jessica J (creator); Lapane, Kate (Director); Miller, Susan (Reader); Eaton, Charles (Reader); Brown University. BIOMED: Epidemiology (sponsor)
Genre:: theses
Subject:: Antipsychotics; Older Adults; Antipsychotic drugs; Dementia; Older people; Nursing homes
Extent:: xix, 82 p.
DOI: https://doi.org/10.7301/Z0HH6H8Z

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Abstract:: Dementia is a progressive, fatal neurodegenerative condition characterized by deterioration in cognition and memory, progressive impairment in the ability to carry out activities of daily living, and a number of behavioral and psychological symptoms. Antispychotics are the most commonly prescribed class of psychoactive medications for behavioral and psychological symptoms of dementia. Recently, concerns have surfaced that antipsychotic medications may cause mortality in older adults. The objective of this dissertation was to investigate potential mechanisms of antipsychotic-induced mortality. For all studies, we used the Minimum Data Set, a collection of standardized assessments that all nursing homes are required to complete for each of their residents at specified times. The Minimum Data Set was then linked to the Medicaid Analytic Extract, a centralized collection of state Medicaid claims for payment. Our study population for all three studies consisted of long-stay nursing home residents with dementia residing in nursing homes in California, Florida, Ohio, New York and Illinois between 2001 and 2002. We conducted a retrospective cohort study in which we matched residents within facility and on level of cognitive impairment. We found that concomitant cholinesterase inhibitor use in residents taking atypical antipsychotics was associated with a reduced risk of mortality. These findings suggest that mortality may be mediated through cholinergic pathways and, if confirmed, could have important ethical and economic implications for how patients with dementia are treated in the nursing home. To quantify the effect of antipsychotic use on the risk of diabetes onset and hip fracture, we also conducted two nested case-control studies in which we matched residents within nursing home and on yearly quarter of Minimum Data Set assessment date. We found that conventional but not atypical antipsychotic use was associated with an increased risk of diabetes onset. Both atypical and conventional antipsychotic use was associated with an increased risk of hip fracture, with long-term use of antipsychotics conferring a greater risk of hip fracture than short-term use. Developing diabetes or sustaining a hip fracture are associated with increased mortality and would add to the substantial comorbidity burden already shouldered by this population.
Notes:: Thesis (Ph.D. -- Brown University (2010)

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Rights: In Copyright
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Jalbert, Jessica J., "A Riddle Wrapped In a Mystery Inside An Enigma: Antipsychotics and Mortality In Persons With Dementia" (2010). Epidemiology Theses and Dissertations. Brown Digital Repository. Brown University Library. https://doi.org/10.7301/Z0HH6H8Z

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Epidemiology Theses and Dissertations

Theses and Dissertations for the Epidemiology department.
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