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[Dysphagia] Dysphagia Digest, Vol 43, Issue 13
Thank you Paula Leslie for a very, very useful article on the use of
dementia and antipsychotics. It will be much more effective than my
statement, " Uhm, death or crying out, death or crying out, I wonder,"
to the dispenser of such at a long-term care facility re a patient who
was subsequently sent out for a diagnosis (thank goodness) of UTI.
Although perhaps not effective with such dispensers, my supervising
nurses may have luck with MDs armed with the article. Many thanks.
Dr. Syd Howard, SLP
On Jun 11, 2007, at 2:00 PM, dysphagia-request at dysphagia.com wrote:
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> Today's Topics:
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> 1. Antipsychotic Drug Use and Mortality in Older Adults with
> Dementia (Leslie, Paula)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Mon, 11 Jun 2007 13:46:07 -0400
> From: "Leslie, Paula" <pleslie at pitt.edu>
> Subject: [Dysphagia] Antipsychotic Drug Use and Mortality in Older
> Adults with Dementia
> To: <dysphagia at b9.com>
> Message-ID:
> <90A1768BD9590C4FB0D7B6CA6550A2555CBBAE at PITT-EXCH-03.univ.pitt.edu>
> Content-Type: text/plain; charset="us-ascii"
>
> Hi All
>
>
>
> I can't remember if this has been posted or not. It might be
> considered
> a little tangential but I have a big interest in dementia. Is someone
> confused or dehydrated? Is it behaviour problems or behaviour
> indicating a problem?
>
>
>
> I know we know this but it might be evidence to help us in some
> scenarios.
>
>
>
> Paula
>
>
>
> Dr Paula Leslie
>
> CertMRCSLT
>
> Associate Professor, Communication Science and Disorders
>
> Specialist Advisor (Swallowing Disorders) RCSLT
>
> University of Pittsburgh
>
> 4033 Forbes Tower
>
> Pittsburgh, PA 15260
>
> tel: (+1) 412- 383-6748 fax: (+1) 412-383-6555
>
> <mailto:pleslie at pitt.edu> pleslie at pitt.edu
>
> <http://www.shrs.pitt.edu/> http://www.shrs.pitt.edu
>
>
>
>
> Antipsychotic Drug Use and Mortality in Older Adults with Dementia
>
>
> <http://www.annals.org/cgi/content/full/146/11/775#FN#FN>
> <http://www.annals.org/cgi/content/full/146/11/775#FN#FN> Sudeep S.
> Gill, MD, MSc; Susan E. Bronskill, PhD; Sharon-Lise T. Normand, PhD;
> Geoffrey M. Anderson, MD, PhD; Kathy Sykora, MSc; Kelvin Lam, MSc;
> Chaim
> M. Bell, MD, PhD; Philip E. Lee, MD; Hadas D. Fischer, MD; Nathan
> Herrmann, MD; Jerry H. Gurwitz, MD; and Paula A. Rochon, MD, MPH
>
>
> 5 June 2007 | Volume 146 Issue 11 | Pages 775-786
>
> Background: Antipsychotic drugs are widely used to manage behavioral
> and
> psychological symptoms in dementia despite concerns about their safety.
>
> Objective: To examine the association between treatment with
> antipsychotics (both conventional and atypical) and all-cause
> mortality.
>
>
> Design: Population-based, retrospective cohort study.
>
> Setting: Ontario, Canada.
>
> Patients: Older adults with dementia who were followed between 1 April
> 1997 and 31 March 2003.
>
> Measurements: The risk for death was determined at 30, 60, 120, and 180
> days after the initial dispensing of antipsychotic medication. Two
> pairwise comparisons were made: atypical versus no antipsychotic use
> and
> conventional versus atypical antipsychotic use. Groups were stratified
> by place of residence (community or long-term care). Propensity score
> matching was used to adjust for differences in baseline health status.
>
> Results: A total of 27 259 matched pairs were identified. New use of
> atypical antipsychotics was associated with a statistically significant
> increase in the risk for death at 30 days compared with nonuse in both
> the community-dwelling cohort (adjusted hazard ratio, 1.31 [95% CI,
> 1.02
> to 1.70]; absolute risk difference, 0.2 percentage point) and the
> long-term care cohort (adjusted hazard ratio, 1.55 [CI, 1.15 to 2.07];
> absolute risk difference, 1.2 percentage points). Excess risk seemed to
> persist to 180 days, but unequal rates of censoring over time may have
> affected these results. Relative to atypical antipsychotic use,
> conventional antipsychotic use was associated with a higher risk for
> death at all time points. Sensitivity analysis revealed that unmeasured
> confounders that increase the risk for death could diminish or
> eliminate
> the observed associations.
>
> Limitations: Information on causes of death was not available. Many
> patients did not continue their initial treatments after 1 month of
> therapy. Unmeasured confounders could affect associations.
>
> Conclusions: Atypical antipsychotic use is associated with an increased
> risk for death compared with nonuse among older adults with dementia.
> The risk for death may be greater with conventional antipsychotics than
> with atypical antipsychotics.
>
>
>
>
>
>
> ------------------------------
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> End of Dysphagia Digest, Vol 43, Issue 13
> *****************************************
>
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