Characteristics and predictors of antipsychotic medication off-label use among community-dwelling older people

Concerns have been raised regarding the common off-label use of antipsychotic (AP) medications among older adults. However, comprehensive knowledge of the determinants of AP off-label use in this population remains limited.

We examined characteristics and predictors of AP off-label use in a nationwide Finnish cohort of community-dwelling older adults with psychiatric morbidity-but without Alzheimer's disease-using longitudinal register data on sociodemographic and illness-related factors. The sample comprised four groups: those prescribed APs off-label (n = 20,563), those with non-psychotic mental disorders without off-label APs (CG1, n = 22,891), those with psychosis or bipolar disorder with APs (CG2, n = 8,966), and those with psychosis or bipolar disorder without APs (CG3, n = 4,585). Sociodemographic and illness-related factors were compared between the off-label and the comparison groups using logistic regression.

Compared to comparison groups, individuals with off-label use more frequently had cardiovascular diseases and strokes. Compared to CG1 and CG3, individuals with AP off-label use were more often female, had a lower prevalence of asthma/chronic obstructive pulmonary disease, and a higher use of psychotropic medications and opioids. Compared to CG2, individuals with off-label use were more often male and had a lower prevalence of diabetes, epilepsy, as well as a lower use of psychotropic medications and a higher use of opioids. Risperidone (43%) and quetiapine (39%) were the most used APs off-label.

Alternative treatments are needed to curb off-label AP use among community-dwelling older adults, given the high prevalence of cardiovascular disease and stroke. Monitoring guidelines are needed to promote safer prescribing practices.