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Final Program


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Brief Oral Papers

Quality, Safety, Research

Brief Oral Papers Session 05 - Quality and Safety

Antipsychotic Use in Hospitalized Elders—A C-L Service Quality Improvement Initiative

Friday, November 8, 2024
11:05 AM – 12:20 PM EST
Location: Flagler
Abstract: Background/Significance: Antipsychotic medications carry an FDA-black-box warning for use in elders with dementia and have well established risks in this population.1 There is evidence that elders are inadvertently discharged from hospitals on antipsychotics that are no longer indicated2 and psychiatric consultation is associated with increased rates of antipsychotic prescribing with intentional recommendation.3 The Consultation Psychiatry Service at Baystate Medical Center currently has no standardized procedures regarding patient follow-up for patients newly initiated on antipsychotics and the frequency of inadvertent antipsychotic prescribing at discharge in this population is unknown. It is also unknown if antipsychotic prescribing at discharge may be biased by social and demographic factors such as race.



Methods: A retrospective chart analysis was performed, querying all elder (65 years of age or older) hospital admissions at Baystate Medical Center from a 1-year period between Jan. 1, 2022 and Dec. 31, 2022 who received psychiatric consultation during admission. Variables extracted from the electronic medical record include age, gender (patient-identified), race and ethnicity, language, homelessness status, insurance, diagnosis of or suspected dementia, antipsychotic medications initiated, discharge disposition, antipsychotic medication included on discharge, and reason for antipsychotic on discharge as determined by manual review of the patient record. The study was submitted to the Baystate Medical Center Institutional Review Board (2083818-2) and was recommended as a hospital-supported quality improvement initiative, approved and endorsed by the Department of Psychiatry.



Results: Over the one-year study period there were 417 unique patient admissions for elders with psychiatric consultation. Mean patient age was 74.6 (65-103) with 50.6% of the sample identifying as male. 89% of the sample self-reported as white, 7.4% as black, and 10.3% identified as Hispanic. Further data analysis is pending.



Discussion: The racial breakdown of our sample reflects the general population of the primary county served by our hospital. While full results of our data analysis are pending, we hypothesize that our sample will include patients who were inadvertently discharged on antipsychotic medication and that this is more likely for non-English speaking patients and for patients with suspected or diagnosed dementia.

Conclusion/Implications: To our knowledge, this is the first study to specifically examine rates of antipsychotic prescribing at discharge for elders followed by a Consultation-Liaison psychiatry service and to examine how structural vulnerabilities such as race, language, and housing status, may impact prescribing habits.