title: Persistence of Antipsychotic Treatment in Elderly Dementia Patients: A Retrospective, Population-Based Cohort Study.
abstract: BACKGROUND
  Antipsychotics are commonly used to manage behavioral and psychological symptoms of dementia. Concerns over their safety and efficacy in this role have resulted in antipsychotics typically being recommended for short-term usage only when used among dementia patients. However, there is little work examining the duration of antipsychotic treatment in the elderly dementia patient population.
  
  
  OBJECTIVE
  To determine the persistence of use of antipsychotics in elderly dementia patients and the role of dose on therapy duration.
  
  
  METHODS
  A retrospective, population-based cohort study using administrative data, including dispensing records from a provincial public drug program, from Ontario, Canada between 2009 and 2012. Elderly dementia patients newly initiated onto antipsychotics were followed until drug discontinuation, death, 2-year follow-up, or end of study. Competing risk analysis was performed to determine time to discontinuation, stratified by categories of initial dose.
  
  
  RESULTS
  After 2 years 49.1 % of the cohort (N= 22,927 of 46,695) had discontinued treatment. When stratified by dose, the high-dose group (51.1 % discontinued) discontinued more frequently than the medium- (48.7 % discontinued) and low- (47.5 % discontinued) dose groups (p< 0.0001).
  
  
  CONCLUSIONS
  Approximately half of elderly dementia patients treated with antipsychotics discontinue within 2 years, with those on higher doses more likely to discontinue. However, the number of patients remaining on therapy represents a serious public health concern.
authors.affiliation: St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada.
authors.forename: Gavin
authors.initials: G
authors.lastname: Mast
authors.affiliation: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON Canada.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Fernandes
authors.affiliation: St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada ; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON Canada ; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON Canada.
authors.forename: Mina
authors.initials: M
authors.lastname: Tadrous
authors.affiliation: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON Canada.
authors.forename: Diana
authors.initials: D
authors.lastname: Martins
authors.affiliation: Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON Canada ; Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.affiliation: St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada ; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON Canada ; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON Canada ; Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes