Antipsychotic Prescribing in Older Adults after In-Hospital Initiation

Area of Science:

• Geriatric Medicine
• Psychopharmacology
• Health Services Research

Background:

• Antipsychotic use in older adults for delirium or dementia-related behaviors carries risks.
• Hospital-initiated antipsychotics may be continued post-discharge without clear indication.
• Data on antipsychotic continuation in older adults after hospitalization in the Saskatchewan Health Authority (SHA) - Regina area is lacking.

Purpose of the Study:

• To determine the rates and duration of antipsychotic continuation in older adults after hospital discharge.
• To identify prescribing patterns, risk factors, and pharmacist involvement in post-discharge antipsychotic therapy.
• To assess the presence of discontinuation or tapering plans for antipsychotics in this population.

Main Methods:

• Retrospective chart review of inpatients aged 65+ discharged from SHA - Regina area hospitals.
• Inclusion period: September 30, 2021, to June 28, 2022.
• Analysis included outpatient dispensing data to track medication continuation.

Main Results:

• 31.7% of 189 older adults continued antipsychotics at discharge.
• Continuation rates at 30, 90, and 180 days post-discharge were 80.0%, 55.0%, and 40.0%, respectively.
• Only 15.0% of patients with continued therapy had documented outpatient follow-up plans.

Conclusions:

• Post-discharge antipsychotic continuation in older adults is common and aligns with existing literature.
• Patients face a high risk of long-term antipsychotic use without adequate follow-up planning.
• Quality improvement initiatives should focus on medication reviews, indication documentation, and regular reassessment of antipsychotic therapy.