DOI: 10.1002/alz.080674 ISSN: 1552-5260

Associations of antipsychotic medication use with mortality, stroke, and myocardial infarction among long‐term nursing home Medicare beneficiaries

Hamid Okhravi, Fang Fang, Brynn E Sheehan
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



In 2005, the Food and Drug Administration issued a black box warning regarding increased mortality and cardiovascular accidents with the off‐label use of antipsychotic medication (APM) in patients with dementia. To improve the quality of care for patients with dementia in nursing homes (NH), in early 2012, the Centers for Medicare & Medicaid Services launched the National Partnership (NP) aimed at combatting the excessive use of APM. Within five years of the partnership, the number of antipsychotic prescriptions in NHs decreased by 34%. The objective of the present study was to examine how APM use has impacted other outcomes, including mortality and major cardiovascular events such as stroke and myocardial infarction (MI) among NH residents with dementia.


We analyzed Medicare data on a sample of 611,773 long‐term NH residents with dementia, aged 50 years and older, from 2011 through 2016. Residents who had received hospice care during the time period were excluded. Cross‐sectional (by year) logistic regressions were conducted to examine the associations of APM use with death, stroke, and MI in the years 2011‐2016. Regression models were adjusted for demographic and co‐morbidity indicators.


Logistic regressions (see results in Table 1) revealed that NH residents prescribed APM had a significantly higher probability of death compared to non‐users from 2011 through 2015. However, in 2016, the probability of death was lower among APM users than non‐users, although the association was weak. Additionally, NH residents who were on APM were less likely to have a stroke or MI than non‐users from 2011 through 2016.


Current study findings suggest that APM use is likely associated with a heightened probability of death among long‐term NH residents, which is consistent with previous literature. The finding that APM use is negatively associated with stroke and MI is inconsistent with prevailing understandings that APM use would lead to higher risks of these outcomes. The shift in the likelihood of death in 2016, and negative associations with stroke and MI warrant further investigation as to the possible contributing factors of death and cardiovascular events in NH residents on antipsychotic medications.

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