School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
Schlegel Research Institute for Aging, Waterloo, Ontario, Canada.
Int J Geriatr Psychiatry. 2019 Jul;34(7):906-920. doi: 10.1002/gps.5106. Epub 2019 Apr 23.
OBJECTIVE/BACKGROUND: Antipsychotic use appears to increase mortality risk among older adults with dementia. Whether this risk is similar for regular or intermittent use is unknown. This scoping review aims to explore the temporal association between antipsychotic use and mortality risk for older institutionalized adults.
We conducted a scoping review using Medline (PubMed), EMBASE, CINAHL, and the Cochrane libraries between October 2018 and January 2019.
Twenty-eight articles met review criteria. We found that different antipsychotic medications present different safety profiles. The risk of mortality was highest with conventional antipsychotic use and within 40 days of antipsychotic initiation.
Conventional antipsychotic use increases mortality for older institutionalized adults. The evidence for atypical antipsychotics is less clear. Mortality risk appears highest within 30 to 40 days of initiating antipsychotic treatment. This temporal association suggests increased mortality may actually be the result of some previously unrecognized illness, comorbidity, change in health status, or increased frailty, rather than an idiosyncrasy of the antipsychotic itself.
目的/背景：抗精神病药物的使用似乎会增加老年痴呆症患者的死亡风险。目前尚不清楚这种风险是否与常规使用或间歇性使用有关。本范围综述旨在探讨老年住院患者抗精神病药物使用与死亡风险之间的时间关联。
我们使用 Medline（PubMed）、EMBASE、CINAHL 和 Cochrane 图书馆于 2018 年 10 月至 2019 年 1 月进行了范围综述。
有 28 篇文章符合审查标准。我们发现，不同的抗精神病药物具有不同的安全性特征。使用传统抗精神病药物和在开始使用抗精神病药物后的 40 天内，死亡风险最高。
传统抗精神病药物的使用会增加老年住院患者的死亡率。非典型抗精神病药物的证据则不太明确。在开始抗精神病药物治疗的 30 至 40 天内，死亡率风险最高。这种时间关联表明，增加的死亡率可能实际上是由于一些以前未被认识到的疾病、合并症、健康状况的变化或脆弱性的增加，而不是抗精神病药物本身的特殊性所致。
