Association between opioid use disorder and palliative care: a cohort study using linked health administrative data in Ontario, Canada
Lau J, Scott MM, Everett K, Gomes T, Tanuseputro P, Jennings S, Bagnarol R, Zimmermann C, Isenberg SR. CMAJ. 2024;
Background — Antipsychotics are commonly used to manage behavioral and psychological symptoms of dementia. Concerns over their safety and efficacy in this role have resulted in antipsychotics typically being recommended for short-term usage only when used among dementia patients. However, there is little work examining the duration of antipsychotic treatment in the elderly dementia patient population.
Objective — To determine the persistence of use of antipsychotics in elderly dementia patients and the role of dose on therapy duration.
Methods — A retrospective, population-based cohort study using administrative data, including dispensing records from a provincial public drug program, from Ontario, Canada between 2009 and 2012. Elderly dementia patients newly initiated onto antipsychotics were followed until drug discontinuation, death, 2-year follow-up, or end of study. Competing risk analysis was performed to determine time to discontinuation, stratified by categories of initial dose.
Results — After 2 years 49.1 % of the cohort (N = 22,927 of 46,695) had discontinued treatment. When stratified by dose, the high-dose group (51.1 % discontinued) discontinued more frequently than the medium- (48.7 % discontinued) and low- (47.5 % discontinued) dose groups (p < 0.0001).
Conclusion — Approximately half of elderly dementia patients treated with antipsychotics discontinue within 2 years, with those on higher doses more likely to discontinue. However, the number of patients remaining on therapy represents a serious public health concern.
Mast G, Fernandes K, Tadrous M, Martins D, Herrmann N, Gomes T. Drugs Real World Outcomes. 2016; 3(2):175-82. Epub 2016 May 13.
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