We will investigate drugs which are used to treat people who have a major mental illness (psychosis) and are aged 80 years or older. We will investigate whether the rates of fractures and/or death are elevated in those prescribed these medications (antipsychotics) compared with patients who were not.
We will describe how antipsychotics were prescribed and then examine the relationships between the chance of having a fracture and/or death and these medications, while adjusting for factors that could influence the outcome (i.e. how frail they are, dementia and use of other types of medications).
Use of newer antipsychotics has been discouraged for older people by the Government in 2009 as these drugs were identified as potential risk factors in strokes. We will evaluate this new policy by looking at utilisation of antipsychotics over time and differences in the rates of fractures and/or death before and after 2009.
Finally, we will examine the interaction between medication types (antipsychotics and other similar medications) and whether the participant is feeble or whether the participant has dementia with the outcome to investigate whether these medications increase the chance of having fracture and/or death versus being frail, having dementia or having been prescribed antipsychotics alone.
Fractures are a serious cause of mortality and morbidity in those over 80 years old and there is interest in identifying ameliorable predictors.
We aim to determine whether use of antipsychotics may be associated with elevated risk of a fall / fracture or death in this vulnerable cohort. A prospective cohort study will be conducted using electronic health records of adults 80 years of age and over for 2006 to 2017.
We will evaluate relative rates of fractures and/or death (simultaneously adjusting for confounding variables and potential interactions) employing a variety of statistical methods (survival analysis with competing risks, poisson, logistic regression and hierarchical multilevel modelling) using CPRD data of all eligible participants over the time-period of a decade. Outcomes will be confirmed by analysis of linked data from Hospital Episode Statistics (HES) where available.
We will investigate changes in these outcomes pre and post guidance in 2009 that recommended cessation of the use of atypical antipsychotics in those over 80 years old. We will stratify these analyses by presence/absence of dementia category.
Rafael Gafoor - Chief Investigator - King's College London (KCL)
Rafael Gafoor - Corresponding Applicant - King's College London (KCL)
Martin Gulliford - Collaborator - King's College London (KCL)
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation