A large U.S. study found that older adults who discontinued antipsychotic medications following hospitalization had lower risks of rehospitalization, delirium, and mortality compared with those who continued use.
Investigators analyzed data from more than 27,000 adults aged 65 years and older who filled an antipsychotic medications (APM) prescription within 30 days of hospital discharge. All patients had no prior psychiatric diagnoses or history of APM use, indicating that the medications were likely prescribed for delirium or behavioral symptoms during hospitalization.
The analysis compared two groups: those who stopped APMs and those who continued. Discontinuation was defined as a gap of at least 45 days between prescription refills.
Over a 180-day follow-up, APM discontinuation was associated with an 11% reduced risk of rehospitalization (hazard ratio [HR] = 0.89, 95% confidence interval [CI] = 0.85–0.94), a 13% lower risk of inpatient delirium (HR = 0.87, 95% CI = 0.79–0.96), a 23% lower risk of fall-related emergency visits or hospitalizations (HR = 0.77, 95% CI = 0.67–0.90), and a 21% lower risk of urinary tract infection hospitalizations (HR = 0.79, 95% CI = 0.66–0.94).
Those who discontinued the treatment also had a 23% reduced risk of all-cause mortality within 6 months (HR = 0.77, 95% CI = 0.69–0.86), based on Medicare data, where mortality tracking was more complete.
There were no statistically significant differences in pneumonia (HR = 0.88, 95% CI = 0.73–1.06) or stroke (HR = 1.22, 95% CI = 0.97–1.53) between groups.
The investigators matched over 13,000 patient pairs based on 162 variables—including age, sex, race, frailty, dementia, and health care use—to control for confounding. The results remained consistent across subgroups defined by dementia status, sex, race, age, APM type, dose, and duration of use.
Among patients 85 years or older, discontinuation was still linked to better outcomes. Patients prescribed haloperidol or atypical antipsychotics such as quetiapine and risperidone had similar results.
Quetiapine was the most prescribed antipsychotic (59.2%), followed by risperidone (21.5%), olanzapine (11.7%), and haloperidol (6.0%).
The investigators noted that the findings supported reassessing APM use after discharge, especially among patients without psychiatric disorders. The study didn't include patients taking long-term antipsychotics for conditions such as schizophrenia.
Limitations included reliance on administrative claims data, which don't capture clinical details like symptom severity or inpatient medication use. However, the investigators conducted multiple sensitivity and subgroup analyses to confirm the robustness of the results.
The study highlighted the need to evaluate the necessity of continuing APMs following acute hospitalization in older adults, aiming to reduce avoidable risks.
Full disclosures can be found in the study.
Source: JAMA Psychiatry
