Get access

Older Men with Dementia Are at Greater Risk than Women of Serious Events After Initiating Antipsychotic Therapy

Authors

  • Paula A. Rochon MD, MPH,

    Corresponding author
    1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    3. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    • Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
    Search for more papers by this author
  • Andrea Gruneir PhD,

    1. Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
    2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    3. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    Search for more papers by this author
  • Sudeep S. Gill MD, MSc,

    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    2. St. Mary's of the Lake Hospital, Kingston, Ontario, Canada
    3. Department of Medicine, Queen's University, Kingston, Ontario, Canada
    Search for more papers by this author
  • Wei Wu MSc,

    1. Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
    Search for more papers by this author
  • Hadas D. Fischer MD, MSc,

    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    Search for more papers by this author
  • Susan E. Bronskill PhD,

    1. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    2. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    Search for more papers by this author
  • Sharon-Lise T. Normand PhD,

    1. Department of Health Care Policy, School of Medicine, Harvard University, Boston, Massachusetts, USA
    2. Department of Biostatistics, School of Public Health, Harvard University, Boston, Massachusetts, USA
    Search for more papers by this author
  • Peter C. Austin PhD,

    1. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    2. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    3. Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Dallas P. Seitz MD,

    1. Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
    Search for more papers by this author
  • Chaim M. Bell MD, PhD,

    1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    3. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    4. Mount Sinai Hospital, Toronto, Ontario, Canada
    Search for more papers by this author
  • Longdi Fu MSc,

    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    Search for more papers by this author
  • Lorraine Lipscombe MD, MSc,

    1. Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
    2. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    4. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    Search for more papers by this author
  • Geoffrey M. Anderson MD, PhD,

    1. Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
    2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    3. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    Search for more papers by this author
  • Jerry H. Gurwitz MD

    1. Division of Geriatric Medicine, Department of Medicine, University of Massachusetts, Medical School, Worcester, Massachusetts, USA
    Search for more papers by this author

Address correspondence to Paula A. Rochon, Women's College Research Institute, Women's College Hospital, 790 Bay Street Toronto, Ontario, Canada. E-mail: paula.rochon@wchospital.ca

Abstract

Objectives

To understand how drug therapy differently affects older women and men.

Design

Population-based, retrospective cohort study.

Setting

Ontario, Canada.

Participants

Twenty-one thousand five hundred twenty-six older adults (13,760 women, 7,766 men) with dementia newly started on oral atypical antipsychotic therapy between April 1, 2007, and March 1, 2010.

Measurements

Numbers and rates of serious events. Serious events were defined as a hospital admission or death within 30 days of treatment initiation. Unadjusted and adjusted odds ratios of women and men were compared in the full cohort and in strata based on setting of care, age, Charlson Comorbidity Index (CCI), and antipsychotic dose.

Results

Of 21,526 older adults with a median age of 84, 1,889 (8.8%) had a serious event (1,044 women, 7.6%; 845 men, 10.9%). Of these, 363 women (2.6%) and 355 men (4.6%) died. Men were more likely than women to be hospitalized or die during the 30-day follow-up period (adjusted odds ratio = 1.47, 95% confidence interval = 1.33–1.62) and consistently more likely to experience a serious event in each stratum. A gradient of risk according to drug dose was found for the development of a serious event in women and men.

Conclusion

The risk of developing a serious event shortly after the initiation of antipsychotic therapy was high in women and men with dementia but was consistently higher in older men. This pattern remained the same in strata based on setting of care, age, CCI, and antipsychotic dose.

Ancillary