Antipsychotic Use More Frequent for Off-Label Indications in Older Adults

Antipsychotic use varies by age, with younger adults using antipsychotics for on-label conditions and older adults for off-label conditions. Additionally, determinants such as traumatic brain injury, Parkinson disease, and physical restraint use were associated with higher use of antipsychotics. This research was recently published in the International Journal of Geriatric Psychiatry.

This retrospective study included data from more than 1 million individuals in the United States. Across all age groups, both schizophrenia and bipolar disorder were linked with use of antipsychotics. Antipsychotic use was more common for off-label conditions in older adults, including for dementia, behavioral issues, cognitive deficiency, and use of physical restraint. Hallucinations and delusions were less frequently treated with antipsychotics in these groups. In younger adults, antipsychotics were used more frequently in all symptoms and diseases except for use of physical restraint, which saw its highest rates of antipsychotic use in adults aged 65 to 84 (36%). 

The Minimum Data Set 2.0 data in this study were collected during 2009, with 14 variables of clinical significance determined via logistic regression in a literature search. The definition of antipsychotic use included daily dispensation for the previous 7 days. Clinically significant variables were categorized depending on how strongly they associated with antipsychotics.

The study researchers conclude that “[correlates] of [antipsychotic] use varied by age, with stronger associations between on-label conditions and [antipsychotic] use among younger adults and off-label conditions among older adults. Several less conventional determinants, namely, Parkinson disease, traumatic brain injury, and the use of physical restraints were identified to increase the likelihood of [antipsychotic] use. This study highlights the importance of monitoring for adverse effects for residents of all ages.”

Reference

Jester DJ, Hyer K, Molinari V, Andel R, Rozek E. Age-dependent determinants of antipsychotic use among newly admitted residents of skilled nursing facilities: A population-based study [published online July 8, 2018]. Int J Geriatr Psychiatry. doi: 10.1002/gps.4934