Discontinuation of antipsychotics treatment for elderly patients within a specialized behavioural unit: a retrospective
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RESEARCH ARTICLE
Discontinuation of antipsychotics treatment for elderly patients within a specialized behavioural unit: a retrospective review Raymond LinBin Gao1 · Kate Sungeun Lim2 · Atul Sunny Luthra3,4 Received: 7 April 2020 / Accepted: 24 August 2020 © Springer Nature Switzerland AG 2020
Abstract Background Best practice guidelines recommend regular evaluation of antipsychotics in managing behaviours for dementia patients with a view to de-prescribing, given its significant mortality and adverse outcomes (Reus et al. in Am J Psychiatry 173(5):543–546, 2016, Deprescribing Guidelines and Algorithms in https: //depres cribi ng.org/resour ces/depres cribi ng-guide lines-algorithms/, 2019). The relationship between the dose of antipsychotic and the probability of discontinuation remains unknown in hospitalized dementia patients. Objectives This study aims to examine the relationship between high dose antipsychotic (greater than 62 mg chlorpromazine equivalent daily dose) and antipsychotics discontinuation in hospitalized dementia patients. Setting Specialized Dementia Behavioral Health Program in Hamilton, Ontario, Canada. Method A retrospective chart review was completed from August to December of 2019. A univariate logistic regression model was applied to antipsychotic doss (in chlorpromazine equivalent) and antipsychotic discontinuation outcome at 60 days (Narayan and Nishtala in Eur J Clin Pharmacol 73(12):1665–1672, 2017). A multivariant model was used to assess potential confounders, including other psychiatric medication exposure and Medicines Comorbidity Index (Luthra in J Gerontol Geriatr Res 4(260):2, 2015). Regression and dose–response models were utilized to identify the threshold dose (maximum daily dose). Main outcome measures Antipsychotic discontinuation at 60 days after the last dose. Results A total of 42 patients were eligible for outcome analysis. High dose antipsychotic was associated with worse discontinuation outcomes in both unadjusted (odds ratio, 0.09; 95% confidence interval, 0.02–0.37; p
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