title: Risk of Adverse Outcomes for Older People with Dementia Prescribed Antipsychotic Medication: A Population Based e-Cohort Study.
abstract: BACKGROUND
  Over recent years there has been growing evidence of increased risk of mortality associated with antipsychotic use in older people with dementia. Although this concern combined with limited evidence of efficacy has informed guidelines restricting antipsychotic prescription in this population, the use of antipsycotics remains common. Many published studies only report short-term outcomes, are restricted to examining mortality and stroke risk or have other limitations. The aim of this study was to assess adverse outcomes associated with the use of antipsychotics in older people living with dementia in Wales (UK).
  
  
  METHODS
  This was a retrospective study of a population-based dementia cohort using the Welsh Secure Anonymised Information Linkage databank. The prior event rate ratio (PERR) was used to estimate the influence of exposure to antipsychotic medication on acute cardiac events, venous thromboembolism, stroke and hip fracture, and adjusted Cox proportional hazard models were used to compare all-cause mortality.
  
  
  RESULTS
  A total of 10,339 people aged ≥65 years were identified with newly diagnosed dementia. After excluding those who did not meet the inclusion criteria, 9674 people remained in the main cohort of whom 3735 were exposed to antipsychotic medication. An increased risk of a venous thromboembolic episode [PERR 1.95, 95% confidence interval (CI) 1.83-2.0], stroke (PERR 1.41, 95% CI 1.4-1.46) and hip fracture (PERR 1.62, 95% CI 1.59-1.65) was associated with antipsychotic use. However, there was no long-term increased mortality in people exposed to antipsychotics (adjusted hazard ratio 1.06, 95% CI 0.99-1.13).
  
  
  CONCLUSIONS
  The increase in adverse medical events supports guidelines restricting antipsychotic use in this population.
authors.affiliation: Farr Institute of Health Informatics Research, Swansea University Medical School, Swansea, Wales, UK. m.s.dennis@swansea.ac.uk.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0003-1241-7375
authors.initials: M
authors.lastname: Dennis
authors.affiliation: Cwm Taf Health Board, Port Talbot, Wales, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Shine
authors.affiliation: Farr Institute of Health Informatics Research, Swansea University Medical School, Swansea, Wales, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: John
authors.affiliation: Farr Institute of Health Informatics Research, Swansea University Medical School, Swansea, Wales, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Marchant
authors.affiliation: Farr Institute of Health Informatics Research, Swansea University Medical School, Swansea, Wales, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: McGregor
authors.affiliation: Farr Institute of Health Informatics Research, Swansea University Medical School, Swansea, Wales, UK.
authors.forename: Ronan A
authors.initials: RA
authors.lastname: Lyons
authors.affiliation: Farr Institute of Health Informatics Research, Swansea University Medical School, Swansea, Wales, UK.
authors.forename: Sinead
authors.initials: S
authors.lastname: Brophy
keywords: Antipsychotic medication; Dementia; Mortality; Older people