Mortality and Antipsychotic Drug Use in Elderly Patients With Parkinson Disease in Nursing Homes

Objectives: To evaluate mortality rate in elderly and very elderly (≥85 years) residents with Parkinson disease (PD) in nursing homes (NHs) with and without antipsychotic drugs.

Design: Cross-sectional study.

Participants: All residents with PD from the 6275 NH residents participating in the Impact d'une démarche QUAlité sur l'évolution des pratiques et le déclin fonctionnel des Résidents en Etablissement d'hébergement pour personnes âgées dépendantes (IQUARE) study.

Setting: A total of 175 NHs in Midi-Pyrénées region, South-Western France.

Exposure: Patients with PD taking antipsychotic drugs.

Outcome measurements: All-cause mortality between baseline and 18 months.

Statistical methods: Logistic regression was used to explore baseline characteristics associated with mortality rate and with antipsychotic use at 18 months.

Results: At baseline, among 452 residents with PD, 72 (15.9%) received at least 1 antipsychotic drug. Mortality rates at 18 months in residents with PD with and without antipsychotic use were similar (34.3% and 38.2%, respectively, P = .58). Among factors associated with mortality, a statistically significant increase in mortality rate was found in very old residents (≥85 years of age) [odds ratio (OR) 2.0; 95% confidence interval (CI) 1.3-3.1] or in those with chronic pulmonary disease (OR 3.6; 95% CI 1.5-8.5). Among residents ≥85 years of age, we also found a statistically significant increase in mortality rate in individuals with arterial hypertension (OR 2.8; 95% CI 1.3-5.8). Moreover, a statistically significant increase in prescription of antipsychotic drugs was found in residents who tried to elope (OR 3.8; 95% CI 1.4-10.7) and in those with severe psychiatric diseases (excluding depression) (OR 7.5; 95% CI 4.1-13.6).

Conclusions: In this study investigating factors associated with mortality in old and very old residents with PD in NHs, no significant association was observed with the use of antipsychotics. However, our study suggests that age (≥85 years) or chronic pulmonary disease could be associated with mortality among patients with PD, as well as arterial hypertension in very old patients (≥85 years of age).