title: Short- and long-term mortality risk associated with the use of antipsychotics among 26,940 dementia outpatients: a population-based study.
abstract: OBJECTIVE
  To investigate short- and long-term mortality risk associated with the use of antipsychotics in dementia outpatients, assessing the risk over specific time frames and quantifying the risk by the individual antipsychotics.
  
  
  METHODS
  This population-based study used data from the Norwegian Prescription Database. The study sample included 26,940 dementia outpatients aged 65 years or older prescribed antidementia drugs and psychotropics from Norwegian pharmacies between 2004 and 2010.
  
  
  RESULTS
  Cox survival analyses, adjusted for age, gender, mean daily defined dose, and severe medical conditions, showed that antipsychotic use compared with other psychotropics involved approximately twice the mortality risk in outpatients with dementia. Furthermore, these results are consistent for all investigated time points after first dispensing the drugs (hazard ratio [HR]30 days = 2.1 [95% confidence interval {CI}: 1.6-2.9] to HR 730-2,400 days = 1.7 [95% CI: 1.6-1.9]). Haloperidol was associated with higher mortality risk (HR 30 days = 1.7 [95% CI: 1.0-3.0] to HR 730-2,400 days = 1.4 [95% CI: 1.0-1.9]) than risperidone.
  
  
  CONCLUSIONS
  This first study to observe antipsychotic use and mortality in dementia outpatients over more than 6 years clearly shows that antipsychotics involve increased short- and long-term mortality risk. Physicians may justly consider antipsychotics to be the best option for some dementia patients among available nonpharmacologic and pharmacologic treatments. However, although causal conclusions are precluded due to limited adjustments in the analyses, the findings support the current treatment recommendations that antipsychotics should be avoided or used with great caution.
authors.affiliation: Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway. Electronic address: ellen.melbye.langballe@fhi.no.
authors.forename: Ellen Melbye
authors.initials: EM
authors.lastname: Langballe
authors.affiliation: Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Bo
authors.initials: B
authors.lastname: Engdahl
authors.affiliation: Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Nordeng
authors.affiliation: Wolfson Centre for Age Related Disease, King's College London, London, England.
authors.forename: Clive
authors.initials: C
authors.lastname: Ballard
authors.affiliation: Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Department of Neuroscience, Ward and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Dag
authors.initials: D
authors.lastname: Aarsland
authors.affiliation: Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Akershus University Hospital, Lørenskog, Norway.
authors.forename: Geir
authors.initials: G
authors.lastname: Selbæk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D014150:Antipsychotic Agents / Q000009:adverse effects*; D015331:Cohort Studies; D003704:Dementia / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006220:Haloperidol / Q000009:adverse effects; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009664:Norway; D016016:Proportional Hazards Models; D018967:Risperidone / Q000009:adverse effects; D016019:Survival Analysis
chemical_list: D014150:Antipsychotic Agents; D006220:Haloperidol; D018967:Risperidone
keywords: Antidementia drugs; Norwegian Prescription Database; antipsychotic drugs; mortality