TY  - JOUR
PY  - 2018//
TI  - Relevance of frailty to mortality associated with the use of antipsychotics among community-residing older adults with impaired cognition
JO  - Pharmacoepidemiology and drug safety
A1  - Maxwell, Colleen J.
A1  - Campitelli, Michael A.
A1  - Hogan, David B.
A1  - Diong, Christina
A1  - Austin, Peter C.
A1  - Amuah, Joseph E.
A1  - Lapane, Kate
A1  - Seitz, Dallas P.
A1  - Gill, Sudeep S.
A1  - Gruneir, Andrea
A1  - Wodchis, Walter P.
A1  - Bronskill, Susan E.
SP  - 289
EP  - 298
VL  - 27
IS  - 3
N2  - PURPOSE: To examine the association between new antipsychotic use and mortality over 6 months among community-based older adults with cognitive impairment, and variation in risk by frailty and sex. <br><br>METHODS: We conducted a retrospective cohort study of older (aged 66+) home care clients in Ontario, Canada, using linked administrative health and clinical databases. Included were clients with dementia and/or significant cognitive impairment assessed during April 2008 to March 2013. Frailty was defined using a validated 72-item index. Exposed were those newly dispensed an antipsychotic in the 6 months post cohort entry, with no such claims in the year prior to drug index date. Two-stage matching defined unexposed clients and their index date (matching on age, sex, frailty, assessment year, and propensity score). Outcome was time to death following index date. Cause-specific hazards models were used, and number needed to harm at 6 months was estimated from cumulative incidence function curves. <br><br>RESULTS: Among 4955 matched exposed-unexposed pairs, new antipsychotic users showed a significantly increased hazard of mortality at 1, 3, and 6 months relative to unexposed, with the highest risk observed in the first month (hazard ratio [HR] = 2.08 [95% CI, 1.79-2.43]). At 1 month, risk was significantly higher for robust (HR = 3.72 [95% CI, 2.45-5.66]) vs frail (HR = 1.74 [95% CI, 1.40-2.17], P = .002) clients. The number needed to harm was 22.7 and did not vary by frailty but was lower for men (14.9) than for women (35.0). <br><br>CONCLUSIONS: Risk of antipsychotic-associated mortality was highest in the first month following exposure, varied significantly by client frailty, and was greater among men than among women.<br><br>Copyright © 2018 John Wiley & Sons, Ltd.<p />  <p>Language: en</p>
LA  - en
SN  - 1053-8569
UR  - http://dx.doi.org/10.1002/pds.4385
ID  - ref1
ER  -