Antipsychotics May Increase Risk of Aspiration Pneumonia in Older Adults

Antipsychotics are commonly used in hospitals for non-psychiatric purposes, particularly to manage delirium in older hospitalized patients. A study published in the Journal of the American Geriatrics Society found that patients who received antipsychotics for a non-psychiatric purpose had about 40%-50% increased risk of aspiration pneumonia—an infection that occurs following the ingestion of solids or liquids into the lungs—than hospital patients without antipsychotic exposure.

“This association was robust through multiple analytical approaches and persisted when focusing on individuals with discharge diagnoses of delirium and dementia,” wrote lead author Shoshana Herzig, M.D., M.P.H., of Harvard Medical School and colleagues. The researchers also noted there was no association between antipsychotics and nonaspiration pneumonia, which supports the idea of a causal link between antipsychotic exposure and aspiration pneumonia.

Herzig and colleagues analyzed data on patients admitted to a large academic medical center in Boston from January 2007 through July 2013, excluding psychiatric hospitalizations (to focus on off-label antipsychotic use), transfers from other hospitals, or hospitalizations shorter than 48 hours.

Of the 146,552 hospitalizations included in the analysis, antipsychotics were used in 10,377 cases, or about 7%. Aspiration pneumonia occurred in 557 (0.4%) hospitalizations. The incidence of aspiration pneumonia was 1.2% in patients with antipsychotic exposure and 0.3% in unexposed individuals. After adjusting for factors such as patient age, length of hospital stay, and exposure to other medications, the authors found that antipsychotic exposure resulted in a 1.4-1.5 increased odds of aspiration pneumonia; the risks were the same for typical and atypical antipsychotics.

Herzig and colleagues also found that age did not impact the relative risk of aspiration pneumonia, but they pointed out that overall use of antipsychotics steadily increased with age. Exposure rates were 5.2% for patients 65 and under, 7.3% for patients 65-74, and 12.5% for patients 75 and older. As such, the absolute risks of aspiration pneumonia were higher in patients 75 and older.

“[O]ur findings suggest that targeting older adults for interventions aimed at improving antipsychotic prescribing practices will lead to the greatest absolute reduction in the occurrence of this costly and morbid complication,” the authors wrote.

To read more on this topic, see the Psychiatric News article “Mortality Risk High for Dementia Patients Taking Antipsychotics.”

iStock/shironsov