Deprescribing Antipsychotics Based on Real-World Evidence to Inform Clinical Practice: Safety Considerations in Managing Older Adults with Dementia

Background: Antipsychotics are commonly used in dementia patients but have potential risks that often outweigh clinical benefits. Limited studies have assessed the healthcare utilization and medical costs associated with antipsychotic use, especially those focused on cumulative days of use.Objective...

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Autores principales:	Stephanie Hsieh, Jing Yuan, Z. Kevin Lu, Minghui Li
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	dementia antipsychotics deprescribing real-world evidence older adults Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/9c88137194c74c4b844fca9c5452113e
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spelling	oai:doaj.org-article:9c88137194c74c4b844fca9c5452113e2021-12-01T08:37:57ZDeprescribing Antipsychotics Based on Real-World Evidence to Inform Clinical Practice: Safety Considerations in Managing Older Adults with Dementia1663-981210.3389/fphar.2021.706750https://doaj.org/article/9c88137194c74c4b844fca9c5452113e2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fphar.2021.706750/fullhttps://doaj.org/toc/1663-9812Background: Antipsychotics are commonly used in dementia patients but have potential risks that often outweigh clinical benefits. Limited studies have assessed the healthcare utilization and medical costs associated with antipsychotic use, especially those focused on cumulative days of use.Objectives: To examine clinical and economic burdens associated with different cumulative days of antipsychotic use in older adults with dementia in the United States.Methods: This study used Medicare Current Beneficiary Survey (2015–2017). Older (≥65 years) Medicare beneficiaries with dementia, without concurrent schizophrenia, bipolar disorder, Huntingon’s disease, or Tourette’s syndrome were included. Antipsychotic use was measured using Medicare Part D prescription events. Healthcare utilization was measured as inpatient services, outpatient services, and emergency room (ER) visits. Total medical costs were classified as Medicare and out-of-pocket costs. The logistic regression, negative binomial regression, and generalized linear model with a log link and gamma distribution were used to examine factors, healthcare utilization, and medical costs. Survey sampling weights were applied to generate national estimates.Results: Among older adults with dementia, 13.18% used antipsychotics. Factors associated with antipsychotic use were being Hispanic (OR: 2.90; 95% CI: 1.45, 5.78), widowed (OR: 3.52; 95% CI: 1.46, 8.48), and single (OR: 3.25; 95% CI: 1.53, 6.87). Compared to non-users, antipsychotic use was associated with higher inpatient visits (IRR: 2.11; 95% CI 1.53, 2.90), ER visits (IRR: 1.61; 95% CI: 1.21, 2.13), total costs (β: 0.53; 95% CI: 0.36, 0.71), Medicare costs (β: 0.49; 95% CI 0.26, 0.72), and out-of-pocket costs (β: 0.66; 95% CI: 0.35, 0.97). With the increase in cumulative days of antipsychotic use, the magnitude of clinical and economic burdens was decreased.Conclusion: The significant clinical and economic burdens associated with antipsychotic use, especially with short-term use, provide real-world evidence to inform clinical practice on deprescribing antipsychotics among community-dwelling geriatric dementia patients.Stephanie HsiehJing YuanZ. Kevin LuMinghui LiFrontiers Media S.A.articledementiaantipsychoticsdeprescribingreal-world evidenceolder adultsTherapeutics. PharmacologyRM1-950ENFrontiers in Pharmacology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	dementia antipsychotics deprescribing real-world evidence older adults Therapeutics. Pharmacology RM1-950
spellingShingle	dementia antipsychotics deprescribing real-world evidence older adults Therapeutics. Pharmacology RM1-950 Stephanie Hsieh Jing Yuan Z. Kevin Lu Minghui Li Deprescribing Antipsychotics Based on Real-World Evidence to Inform Clinical Practice: Safety Considerations in Managing Older Adults with Dementia
description	Background: Antipsychotics are commonly used in dementia patients but have potential risks that often outweigh clinical benefits. Limited studies have assessed the healthcare utilization and medical costs associated with antipsychotic use, especially those focused on cumulative days of use.Objectives: To examine clinical and economic burdens associated with different cumulative days of antipsychotic use in older adults with dementia in the United States.Methods: This study used Medicare Current Beneficiary Survey (2015–2017). Older (≥65 years) Medicare beneficiaries with dementia, without concurrent schizophrenia, bipolar disorder, Huntingon’s disease, or Tourette’s syndrome were included. Antipsychotic use was measured using Medicare Part D prescription events. Healthcare utilization was measured as inpatient services, outpatient services, and emergency room (ER) visits. Total medical costs were classified as Medicare and out-of-pocket costs. The logistic regression, negative binomial regression, and generalized linear model with a log link and gamma distribution were used to examine factors, healthcare utilization, and medical costs. Survey sampling weights were applied to generate national estimates.Results: Among older adults with dementia, 13.18% used antipsychotics. Factors associated with antipsychotic use were being Hispanic (OR: 2.90; 95% CI: 1.45, 5.78), widowed (OR: 3.52; 95% CI: 1.46, 8.48), and single (OR: 3.25; 95% CI: 1.53, 6.87). Compared to non-users, antipsychotic use was associated with higher inpatient visits (IRR: 2.11; 95% CI 1.53, 2.90), ER visits (IRR: 1.61; 95% CI: 1.21, 2.13), total costs (β: 0.53; 95% CI: 0.36, 0.71), Medicare costs (β: 0.49; 95% CI 0.26, 0.72), and out-of-pocket costs (β: 0.66; 95% CI: 0.35, 0.97). With the increase in cumulative days of antipsychotic use, the magnitude of clinical and economic burdens was decreased.Conclusion: The significant clinical and economic burdens associated with antipsychotic use, especially with short-term use, provide real-world evidence to inform clinical practice on deprescribing antipsychotics among community-dwelling geriatric dementia patients.
format	article
author	Stephanie Hsieh Jing Yuan Z. Kevin Lu Minghui Li
author_facet	Stephanie Hsieh Jing Yuan Z. Kevin Lu Minghui Li
author_sort	Stephanie Hsieh
title	Deprescribing Antipsychotics Based on Real-World Evidence to Inform Clinical Practice: Safety Considerations in Managing Older Adults with Dementia
title_short	Deprescribing Antipsychotics Based on Real-World Evidence to Inform Clinical Practice: Safety Considerations in Managing Older Adults with Dementia
title_full	Deprescribing Antipsychotics Based on Real-World Evidence to Inform Clinical Practice: Safety Considerations in Managing Older Adults with Dementia
title_fullStr	Deprescribing Antipsychotics Based on Real-World Evidence to Inform Clinical Practice: Safety Considerations in Managing Older Adults with Dementia
title_full_unstemmed	Deprescribing Antipsychotics Based on Real-World Evidence to Inform Clinical Practice: Safety Considerations in Managing Older Adults with Dementia
title_sort	deprescribing antipsychotics based on real-world evidence to inform clinical practice: safety considerations in managing older adults with dementia
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/9c88137194c74c4b844fca9c5452113e
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Deprescribing Antipsychotics Based on Real-World Evidence to Inform Clinical Practice: Safety Considerations in Managing Older Adults with Dementia

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