Atypical antipsychotics linked to 20% higher mortality in older adults hospitalized with pneumonia

  • ERJ Open Research

  • von Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Atypical antipsychotic use (vs nonuse) is associated with 20% higher mortality in older adults ≥65 years hospitalized for pneumonia.

Why this matters

  • Clinicians should minimize prescribing of atypical antipsychotics in older patients, as well as closely monitor patients who are prescribed atypical antipsychotics regardless of reason.

Study design

  • Retrospective cohort of 102,897 patients in the Department of Veterans Affairs Health Care System during a 10-year period.
  • Propensity-matched comparison of 5513 users vs 5513 nonusers of atypical antipsychotics.
  • Funding: National Institute of Nursing Research.

Key results

  • Use of atypical antipsychotics was associated with increased likelihood of 30-day pneumonia mortality (OR, 1.20; 95% CI, 1.11-1.31) and 90-day pneumonia mortality (OR, 1.19; 95% CI, 1.09-1.30).
  • Secondary analysis found that 90-day pneumonia mortality among users of antipsychotics was increased across:
    • The entire cohort (OR, 1.31; 95% CI, 1.22-1.40).
    • Psychiatric patients (OR, 1.21; 95% CI, 1.12-1.30).
    • Preexisting cardiac conditions (OR, 1.22; 95% CI, 1.09-1.36).
  • Secondary analysis did not find increased pneumonia mortality among older adults prescribed atypical antipsychotics for dementia (OR, 0.96; 95% CI, 0.82-1.12).

Limitations

  • Observational design.
  • Older adults in VA hospitals may not be representative of all older adults.