Discontinuing antipsychotics for delirium lowers risks of rehospitalization, mortality

For older adults who received treatment with antipsychotics to manage delirium, medication discontinuation leads to better outcomes, including reduced risks of all-cause rehospitalization and mortality, compared with continued use, according to a study.

Researchers used data from the US Medicare claims and Optum CDM databases. They looked at adults at least 65 years of age without psychiatric disorders, without previous exposure to antipsychotic medications (APMs), and who filled an APM prescription within 30 days of hospital discharge.

Propensity-score matching was performed to match APM discontinuers (gap ≥45 days) to continuers based on the type of APM prescribed, the time since their first APM prescription, and whether they had been admitted to intensive care units prior to the first APM prescription. Study outcomes were rehospitalization, specific rehospitalization reasons, and all-cause mortality.

There were 13,712 propensity score–matched pairs included in the analysis, for an overall sample of 27,424 adults (mean age 81.86 years; 53.8 percent female). Compared with continuers, APM discontinuers had significantly lower risks of rehospitalization (hazard ratio [HR], 0.89, 95 percent confidence interval [CI], 0.85–0.94), inpatient delirium (HR, 0.87, 95 percent CI, 0.79–0.96), fall-related emergency department visits or hospitalizations (HR, 0.77, 95 percent CI, 0.67–0.90), hospitalization with urinary tract infection (HR, 0.79, 95 percent CI, 0.66–0.94), and all-cause mortality (HR, 0.77, 95 percent CI, 0.69-0.86) during a median follow-up of 180 days.

On the other hand, discontinuers and continuers did not significantly differ in terms of the risks of pneumonia (HR, 0.88, 95 percent CI, 0.73–1.06) and stroke (HR, 1.22, 95 percent CI, 0.97–1.53).

Results were consistent in subgroups defined by dementia status, type and dose of APM prescribed, and duration of APM exposure.