Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults

Abstract Background Antipsychotics are prescribed to treat various symptoms in older adults, however, their safety in this context has not been fully evaluated. The objective was to evaluate mortality risks associated with off-label use of antipsychotics among older adults with no preexisting mental illness or dementia relative to those with diagnosis of dementia. Methods Data (2007–2015) were derived from Department of Veterans Affairs registries for 730,226 patients (≥65 years) with no baseline serious mental illness, dementia). We estimated the cumulative incidence of antipsychotics prescription and 10-year all-cause mortality. The extended Cox models were used to estimate Hazard Ratios (HRs) associated with antipsychotics prescription, adjusted for time-varying covariates, dementia diagnosis, comorbidity index score, and age at time of first exposure to antipsychotics. Results The study included 98% males, 13% African Americans, and 81% Caucasian. Patients with dementia and antipsychotics had the highest risk of mortality (78.0%), followed by (73.0%) for patients with dementia alone and compared with patients without dementia or antipsychotics exposure who had the lowest mortality risk (42.0%). Exposure to typical antipsychotics was associated with (HR: 2.1, confidence interval [CI] 2.0–2.2) compared with atypical antipsychotics (HR: 1.5, CI 1.4–1.5, p = <.0001). Conclusion In a large cohort of older adults, antipsychotics were associated with an increased risk of all-cause mortality. While significant increase in mortality was attributable to the diagnosis of dementia, the addition of antipsychotics resulted in added mortality risk among all patients. Antipsychotic medications should be used cautiously in all older adults, not only those with dementia.

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Relationship Between Multimorbidity, Combination and All-Cause Mortality Among Older Adults: A Retrospective Cohort Analysis

10.21203/rs.3.rs-122536/v1 ◽

2020 ◽

Author(s):

Kun He ◽

Wenli Zhang ◽

Xueqi Hu ◽

Hao Zhao ◽

Bingxin Guo ◽

...

Keyword(s):

Older Adults ◽

Mortality Risk ◽

Cox Regression ◽

Cohort Analysis ◽

Relative Effect ◽

Long Term Conditions ◽

Cox Models ◽

Chinese Older Adults ◽

All Cause Mortality ◽

The Impact

Abstract Background: Previous studies have evaluated the association of multimorbidity with higher mortality, but epidemiologic data on the association between the combination of multimorbidity and all-cause mortality risk are rare. We aimed to examine the relationship between multimorbidity (number/combination) and all-cause mortality in Chinese older adults. Methods: We conducted a population-based study of 50,100 Chinese participants. Cox regression models were used to estimate the impact of long-term conditions (LTCs) on all-cause mortality. Results: The prevalence of multimorbidity was 31.35% and all-cause mortality was 8.01% (50,100 participants). In adjusted Cox models, the hazard rations (HRs) and 95% confidence intervals (CIs) of all-cause mortality risk for those with 1, 2, and ≥ 3 LTCs compared with those with no LTCs was 1.10 (1.01-1.20), 1.21 (1.10-1.33), and 1.46 (1.27-1.67), respectively (Ptrend <0.001). In the LTCs ≥ 2 category, the combination of chronic diseases that included hypertension, diabetes, CHD, COPD, and stroke had the greatest impact on mortality. In the stratified model by age and sex, absolute all-cause mortality was higher among the ≥ 75 age group with an increasing number of LTCs. However, the relative effect size of the increasing number of LTCs on higher mortality risk was larger among those < 75 years.Conclusions: The risk of all-cause mortality is increased with the number of multimorbidity among Chinese older adults, particularly combinations.

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Socioeconomic Status, Frailty, and All-Cause Mortality in Korean Older Adults: A 3-Year Population-Based Prospective Study

BioMed Research International ◽

10.1155/2017/1903589 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Jinkyung Cho ◽

Inhwan Lee ◽

Soo Hyun Park ◽

Youngyun Jin ◽

Donghyun Kim ◽

...

Keyword(s):

Older Adults ◽

Socioeconomic Status ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Cox Proportional Hazards Model ◽

Low Ses ◽

Increased Risk ◽

All Cause Mortality

Background. Little is known regarding the effects of socioeconomic status (SES) and frailty on mortality in Korea. Objective. This study investigated the combined impact of low SES and frailty on all-cause mortality in Korean older adults. Methods. Study sample at baseline comprised 7,960 community-dwelling adults (56.8% women) aged 65 years and older. The Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of low SES and frailty for all-cause mortality. Results. Overall, low SES plus frailty resulted in an increased risk of all-cause mortality (HR = 1.56, 95% CI = 1.09–2.23, P=0.015) even after adjustments for all the measured covariates, as compared with high SES plus nonfrailty (HR = 1). Among older adults aged 65–75 years, the increased mortality risk of either low SES plus nonfrailty (HR = 1.37, 95% CI = 1.02–1.84, P=0.038) or high SES plus frailty (HR = 2.09, 95% CI = 1.12–3.91, P=0.021) remained significant even after adjustments for all the covariates, as compared with high SES plus nonfrailty (HR = 1). Conclusion. The current findings suggest that either low SES or frailty is significantly associated with increased all-cause mortality in Korean older adults.

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Endogenous sex hormones and the prospective association with cardiovascular disease and mortality in men: the Tromsø Study

Acta Endocrinologica ◽

10.1530/eje-09-0284 ◽

2009 ◽

Vol 161 (3) ◽

pp. 435-442 ◽

Cited By ~ 105

Author(s):

Torkel Vikan ◽

Henrik Schirmer ◽

Inger Njølstad ◽

Johan Svartberg

Keyword(s):

Cardiovascular Disease ◽

Mortality Risk ◽

Free Testosterone ◽

Community Dwelling ◽

End Points ◽

Testosterone Levels ◽

Increased Risk ◽

All Cause Mortality ◽

Prospective Association ◽

The Impact

ObjectiveTo study the impact of endogenous testosterone levels in community-dwelling men on later risk for myocardial infarction (MI) and all-cause, cardiovascular disease (CVD), and ischemic heart disease (IHD) mortality.DesignPopulation-based prospective cohort study.MethodsFor the analyses, we used a cohort of 1568 randomly selected men, with sex-hormone data participating in the fourth Tromsø Study (1994–1995). Defined end points were first-ever MI (fatal or nonfatal), all-cause, CVD, and IHD mortality. A committee performed thorough ascertainment of end points, following a detailed protocol. Complete ascertainment of end points was until 30 September 2007 for all-cause mortality, until 31 December 2005 for CVD/IHD mortality, and until 31 December 2004 for first-ever MI. The prospective association between total and free testosterone and end points were examined using Cox proportional hazard regression, allowing for multivariate adjustment for age and cardiovascular risk factors.ResultsDuring follow-up, there were 395 deaths from all causes, 130 deaths from CVD and 80 deaths from IHD, while 144 men experienced a first-ever MI. There was a significant increase in all-cause mortality risk for men with free testosterone in the lowest quartile (<158 pmol/l) compared with the higher quartiles after age adjustment hazard ratios (HR 1.24, 95% confidence interval, CI 1.01–1.53) and after multivariate adjustments (HR 1.24, 95% CI 1.01–1.54). Total testosterone was not associated with mortality risk. Likewise, there were no significant changes in risk for first-ever MI across different total or free testosterone levels.ConclusionMen with free testosterone levels in the lowest quartile had a 24% increased risk of all-cause mortality.

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The Association between Allostatic Load and Mortality among Chinese Older Adults: The Chinese Longitudinal Health and Longevity Study

10.21203/rs.3.rs-31124/v1 ◽

2020 ◽

Author(s):

Tianhang Zhang ◽

Lijing Yan ◽

Huashuai Chen ◽

Haiyu Jin ◽

Chenkai Wu

Keyword(s):

Older Adults ◽

Allostatic Load ◽

Adverse Outcomes ◽

Cox Models ◽

Chinese Older Adults ◽

Healthy Longevity ◽

Increased Risk ◽

Significant Difference ◽

All Cause Mortality ◽

Wear And Tear

Abstract Background Allostatic load, as multiple biomarker measures of ‘wear and tear’ on physiological systems, has shown some promise that high burden of AL is associated with increased risk of adverse outcomes, but little attention has been paid to China with largest aging population in the world. This study is to examine the association between allostatic load (AL) and all-cause mortality among Chinese adults aged at least 60 years. Methods Data were from 2,439 participants in the Chinese Longitudinal Healthy Longevity Survey. The final analytic sample consisted of 1,519 participants. Cox models were used to examine the association between AL and mortality among men and women, separately. Analysis were also adjusted for potential confounders including age, ethnicity, education, and marital status, smoking and exercise. Results In the fully adjusted model, males with a medium AL burden (score: 2–4) and high AL burden (score: 5–9) had a 34% and 128% higher hazard of death, respectively, than those with a low AL burden (score: 0–1). We did not find significant difference between females with different levels of AL burden. Discussion Higher AL burden was associated with increased all-cause mortality among Chinese men aged at least 60 years. However, we did not find strong evidence about Allostatic load was associated with specific causes of death over the same follow-up period among women. In conclusion Intervention programs targeting modifiable components of the AL burden may help prolong lifespan for older adults, especially men, in China.

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Abstract 31: Higher Levels of Light Intensity Physical Activity and Lower Sedentary Time are Associated With a Lower Risk of All-cause Mortality in Older Adults: The Framingham Heart Study

Circulation ◽

10.1161/circ.141.suppl_1.31 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Joowon Lee ◽

Nicole L Spartano ◽

Ramachandran S Vasan ◽

Vanessa Xanthakis

Keyword(s):

Physical Activity ◽

Older Adults ◽

Light Intensity ◽

Mortality Risk ◽

Lower Risk ◽

Sedentary Time ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

All Cause Mortality ◽

Community Dwelling Older Adults

Introduction: Habitual physical activity (PA) and less sedentary behavior have been associated with a lower risk of mortality in middle-aged adults. However, little is known about the associations of objectively-assessed PA of varying levels and sedentary time with mortality in community-dwelling older adults. Hypothesis: We hypothesized that higher overall PA and less sedentary time will be associated with a lower risk of all-cause mortality in older adults. Methods: We evaluated 1,262 Framingham Offspring Study participants (mean age 69 yrs, 54% women) with accelerometry-derived PA data (wear time ≥10 hours/day for at least 4 days using an Actical device) at their ninth examination (2011-2014). Multivariable Cox proportional hazards regression models were used to relate PA and sedentary time (separate model for each) with all-cause mortality adjusting for potential confounders. In sensitivity analysis to mitigate the potential impact of frailty on the associations evaluated, we excluded those with frailty at baseline. Results: Overall, 67 participants died during a median follow-up of 4.8 years (25 th -75 th percentiles: 4.3 - 5.3 [years]). Higher total PA, light intensity PA (LIPA), adherence to PA guidelines, and lower sedentary time were associated with a lower risk of all-cause mortality ( Table ). The results remained statistically significant even after excluding those with frailty. Higher LIPA and lower sedentary time were associated with a lower risk of all-cause mortality regardless of MVPA in both models including all participants and excluding those with frailty. Conclusions: In our investigation of a moderate-size sample of community-dwelling older adults, we confirmed that being physically active substantially lowered mortality risk. Additionally, our findings suggest that reducing sedentary time and increasing LIPA (regardless of MVPA) may be sufficient to reduce mortality risk in older adults. Additional studies of larger multi-ethnic samples of older adults are warranted to confirm our findings.

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Impact of anemia on hospitalization and mortality in older adults

Blood ◽

10.1182/blood-2005-10-4308 ◽

2006 ◽

Vol 107 (10) ◽

pp. 3841-3846 ◽

Cited By ~ 193

Author(s):

Bruce F. Culleton ◽

Braden J. Manns ◽

Jianguo Zhang ◽

Marcello Tonelli ◽

Scott Klarenbach ◽

...

Keyword(s):

Older Adults ◽

Proportional Hazards ◽

Prognostic Significance ◽

The Elderly ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Normal Kidney ◽

Increased Risk ◽

All Cause Mortality ◽

Community Dwelling Older Adults

Although anemia is common in older adults, its prognostic significance is uncertain. A total of 17 030 community-dwelling subjects 66 years and older were identified between July 1 and December 31, 2001, and followed until December 31, 2004. Cox proportional hazards analyses were performed to determine the associations between anemia (defined as hemoglobin < 110 g/L) and hemoglobin and all-cause mortality, all-cause hospitalization, and cardiovascular-specific hospitalization. Overall, there were 1983 deaths and 7278 first hospitalizations. In patients with normal kidney function, adjusting for age, sex, diabetes mellitus, and comorbidity, anemia was associated with an increased risk for death (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.55-5.12), first all-cause hospitalization (HR, 2.16; 95% CI, 1.88-2.48), and first cardiovascular-specific hospitalization (HR, 2.49; 95% CI, 1.99-3.12). An inverse J-shaped relationship between hemoglobin and all-cause mortality was observed; the lowest risk for mortality occurred at hemoglobin values between 130 to 150 g/L for women and 140 to 170 g/L for men. Anemia is associated with an increased risk for hospitalization and death in community-dwelling older adults. Consideration should be given to redefine “normal” hemoglobin values in the elderly. Clinical trials are also necessary to determine whether anemia correction improves quality or quantity of life in this population.

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Control of blood pressure and risk of mortality in a cohort of older adults: the Berlin Initiative Study

European Heart Journal ◽

10.1093/eurheartj/ehz071 ◽

2019 ◽

Vol 40 (25) ◽

pp. 2021-2028 ◽

Cited By ~ 9

Author(s):

Antonios Douros ◽

Markus Tölle ◽

Natalie Ebert ◽

Jens Gaedeke ◽

Dörte Huscher ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Cardiovascular Events ◽

Antihypertensive Treatment ◽

Antihypertensive Drugs ◽

Community Dwelling ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality

Abstract Aims To assess whether blood pressure (BP) values below 140/90 mmHg during antihypertensive treatment are associated with a decreased risk of all-cause mortality in community-dwelling older adults. Methods and results Within the Berlin Initiative Study, we assembled a cohort of patients ≥70 years treated with antihypertensive drugs at baseline (November 2009–June 2011). End of prospective follow-up was December 2016. Cox proportional hazards models yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality associated with normalized BP [systolic BP (SBP) <140 mmHg and diastolic BP (DBP) <90 mmHg] compared with non-normalized BP (SBP ≥140 mmHg or DBP ≥90 mmHg) overall and after stratification by age or previous cardiovascular events. Among 1628 patients (mean age 81 years) on antihypertensive drugs, 636 exhibited normalized BP. During 8853 person-years of follow-up, 469 patients died. Compared with non-normalized BP, normalized BP was associated with an increased risk of all-cause mortality (incidence rates: 60.3 vs. 48.5 per 1000/year; HR 1.26; 95% CI 1.04–1.54). Increased risks were observed in patients ≥80 years (102.2 vs. 77.5 per 1000/year; HR 1.40; 95% CI 1.12–1.74) and with previous cardiovascular events (98.3 vs. 63.6 per 1000/year; HR 1.61; 95% CI 1.14–2.27) but not in patients aged 70–79 years (22.6 vs. 22.7 per 1000/year; HR 0.83; 95% CI 0.54–1.27) or without previous cardiovascular events (45.2 vs. 44.4 per 1000/year; HR 1.16, 95% CI 0.90–1.48). Conclusion Blood pressure values below 140/90 mmHg during antihypertensive treatment may be associated with an increased risk of mortality in octogenarians or elderly patients with previous cardiovascular events.

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The association of weight change and all-cause mortality in older adults: a systematic review and meta-analysis

Age and Ageing ◽

10.1093/ageing/afaa231 ◽

2020 ◽

Author(s):

Tagrid A Alharbi ◽

Susan Paudel ◽

Danijela Gasevic ◽

Joanne Ryan ◽

Rosanne Freak-Poli ◽

...

Keyword(s):

Older Adults ◽

Weight Loss ◽

Weight Gain ◽

Mortality Risk ◽

Weight Change ◽

Meta Analysis ◽

Community Dwelling ◽

Weight Fluctuation ◽

All Cause Mortality ◽

The Impact

Abstract Objective there may be age-related differences in the impact of weight change on health. This study systematically reviewed the evidence on the relationship between weight change and all-cause mortality in adults aged 65 years and older. Methods MEDLINE, EMBASE and CINAHL were searched from inception to 11 June 2020, PROSPERO CRD 42019142268. We included observational studies reporting on the association between weight change and all-cause mortality in older community-dwelling adults. A random-effects meta-analysis was performed to calculate pooled hazard ratios and scored based on the Agency for Healthcare Research and Quality guidelines. Results a total of 30 studies, including 1,219,279 participants with 69,255 deaths, demonstrated that weight loss was associated with a 59% increase in mortality risk (hazard ratio (HR): 1.59; 95% confidence interval (CI): 1.45–1.74; P < 0.001). Twenty-seven studies that reported outcomes for weight gain (1,210,116 participants with 65,481 deaths) indicated that weight gain was associated with a 10% increase in all-cause mortality (HR: 1.10; 95%CI: 1.02, 1.17; P = 0.01). Four studies investigated weight fluctuation (2,283 events among 6,901 participants), which was associated with a 63% increased mortality risk (HR: 1.66; 95%CI: 1.28, 2.15). No evidence of publication bias was observed (all P > 0.05). Conclusion for community-dwelling older adults, weight changes (weight loss, gain or weight fluctuation) are associated with an increased risk of all-cause mortality risk relative to stable weight. Further research is needed to determine whether these associations vary depending upon initial weight, and whether or not the weight loss/gain was intentional.

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Association between allostatic load and mortality among Chinese older adults: the Chinese Longitudinal Health and Longevity Study

BMJ Open ◽

10.1136/bmjopen-2020-045369 ◽

2021 ◽

Vol 11 (8) ◽

pp. e045369

Author(s):

Tianhang Zhang ◽

Lijing L Yan ◽

Hua-Shuai Chen ◽

Hai-Yu Jin ◽

Chenkai Wu

Keyword(s):

Older Adults ◽

Allostatic Load ◽

Strong Association ◽

Population Based ◽

Adverse Outcomes ◽

Ageing Population ◽

Cox Models ◽

Increased Risk ◽

Significant Difference ◽

All Cause Mortality

BackgroundAllostatic load (AL) has shown that high burden of AL is associated with increased risk of adverse outcomes, but little attention has been paid to China with largest ageing population in the world.ObjectiveThis study is to examine the association between AL and all-cause mortality among Chinese adults aged at least 60 years.DesignPopulation-based prospective cohort study.SettingIn 2011–2012, an ancillary study, in which a blood test was added, including a total of 2439 participants, was conducted in eight longevity areas in the Chinese Longitudinal Healthy Longevity Survey.ParticipantsThe final analytical sample consisted of 1519 participants (mean±SD age: men 80.5±11.3 years; women 90.2±11.8 years and 53% women).Primary outcome measureCox models were used to examine the association between AL and mortality among men and women, separately. Analyses were also adjusted for potential confounders including age, ethnicity, education and marital status, smoking and exercise.ResultsMale with a medium AL burden (score: 2–4) and high AL burden (score: 5–9) had a 33% and 118% higher hazard of death, respectively, than those with a low AL burden (score: 0–1). We did not find significant difference between females with different levels of AL burden.ConclusionHigher AL burden was associated with increased all-cause mortality among Chinese men aged at least 60 years. However, we did not find strong association among women. In conclusion, Intervention programmes targeting modifiable components of the AL burden may help prolong lifespan for older adults, especially men, in China.

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Influenza vaccine effectiveness against all-cause mortality following laboratory-confirmed influenza in older adults, 2010-2011 to 2015-2016 seasons in Ontario, Canada

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1862 ◽

2020 ◽

Author(s):

Hannah Chung ◽

Sarah A Buchan ◽

Aaron Campigotto ◽

Michael A Campitelli ◽

Natasha S Crowcroft ◽

...

Keyword(s):

Older Adults ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Influenza A ◽

Vaccine Effectiveness ◽

Community Dwelling ◽

Administrative Databases ◽

Increased Risk ◽

Influenza A H1n1 ◽

All Cause Mortality

Abstract Background Older adults are at increased risk of mortality from influenza infections. We estimated influenza vaccine effectiveness (VE) against mortality following laboratory-confirmed influenza. Methods Using a test-negative design study and linked laboratory and health administrative databases in Ontario, Canada, we estimated VE against all-cause mortality following laboratory-confirmed influenza for community-dwelling adults aged >65 years during the 2010-2011 to 2015-2016 influenza seasons. Results Among 54,116 older adults tested for influenza across the 6 seasons, 6,837 died within 30 days of specimen collection. Thirteen percent (925 individuals) tested positive for influenza, and 50.6% were considered vaccinated for that season. Only 23.2% of influenza test-positive cases had influenza recorded as their underlying cause of death. Before and after multivariable adjustment, we estimated VE against all-cause mortality following laboratory-confirmed influenza to be 20% (95%CI, 8%-30%) and 20% (95%CI, 7%-30%), respectively. This estimate increased to 34% after correcting for influenza vaccination exposure misclassification. We observed significant VE against deaths following influenza confirmation during 2014-2015 (VE=26% [95%CI, 5%-42%]). We also observed significant VE against deaths following confirmation of influenza A/H1N1 and A/H3N2, and against deaths with COPD as the underlying cause. Conclusions These results support the importance of influenza vaccination in older adults, who account for most influenza-associated deaths annually.

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