Antipsychotic use in nursing home residents admitted with hip fracture

Abstract

Objectives: To evaluate the association between receiving antipsychotics and the outcomes of a cohort of nursing home (NH) residents with and without presumed delirium after hip fracture.

Design: Population-based cohort study.

Setting: Eleven thousand one hundred nineteen nursing homes nationwide from January 1, 2000, to December 31, 2007.

Participants: First-time NH admissions with hip fracture (n = 77,759).

Measurements: The Nursing Home Confusion Assessment Method was used to identify residents with no delirium, subsyndromal delirium, and full delirium. Propensity score reweighting was used, with analyses stratified according to delirium level.

Results: In subjects with no delirium symptoms, approximately 5% (n = 3,250) received antipsychotic drugs. These individuals were less likely to be discharged home (odds ratio (OR) = 0.68, P < .001), had a higher likelihood of death before nursing home discharge (OR = 1.28, P = .03), stayed in nursing homes longer (β 2.83, P = .05), and had less functional improvement at discharge (β -0.47, P = .03). Receipt of antipsychotics in participants with mild delirium was associated with a lower likelihood of discharge home (OR = 0.74, P = .03).

Conclusion: In NH residents with hip fracture and no delirium symptoms, use of antipsychotics was associated with worse outcomes, with the exception of rehospitalization. No clear benefits were associated with antipsychotic use for those with presumed delirium.