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Off-Label Use of Antipsychotics and Health Related Quality of Life in Community Living Older Adults

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Abstract

To determine the relationship between off-label use of antipsychotics (AP) and health related quality of life (HRQL) in older adults. This study was based on n = 1020 community living older adults, participating in the ‘Étude sur la santé des ainés’ (ESA)-Services longitudinal study (2010–2015) and covered under Quebec’s public drug insurance plan. Off-label use of AP was identified via the province of Quebec’s health administrative and pharmaceutical databases « Régie d’Assurance Maladie du Québec » (RAMQ). Off-label use was defined by the presence of an AP and the absence, during the same one-year period, of an approved indication by Health Canada. HRQL was measured using a visual analogue scale (HRQL-VAS) and based on functional health status (HRQL-FHS). Multiple linear regressions were used to assess the association between AP use and HRQL at baseline and the change in HRQL at three years follow-up. HRQL-FHS at baseline was positively associated with off-label use of AP compared to on-label use [B = 0.26; 95% CI: 0.12; 0.40]. However, the change in HRQL-FHS was negatively associated with off-label use of AP compared to on-label use [B = −0.18; 95% CI: -0.33; −0.04], and compared to non-use [B = −0.10; 95% CI: -0.18; −0.03]. No association was observed with the HRQL-VAS. Off-label AP users reported better functional health status at baseline, reflecting lower disease severity. The decline in HRQL over the 3-year period in off-label AP use may reflect a lack of AP use efficacy in preventing health status decline.

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Acknowledgments

We would like to thank the biostatistician Djamal Berbiche who prepared the data and contributed to the data analyses.

This research was conducted at the Charles-Le Moyne Hospital Research Center.

Funding

The ESA-Services study was also supported by a CIHR research grant (201403MOP). Dr. Bakouni holds an MSc scholarship from the HCLM research center. Dr. Vasiliadis is a Senior Research Scholar with the FRQ-S.

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Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, J1K 2R1, Canada

    Hamzah Bakouni & Helen-Maria Vasiliadis

  2. Centre de recherche – Hôpital Charles-Le Moyne, Université de Sherbrooke, Campus Longueuil, 150 Place Charles-Le Moyne bureau 200, Longueuil, QC, J4K 0A8, Canada

    Hamzah Bakouni & Helen-Maria Vasiliadis

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  1. Hamzah Bakouni
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Contributions

Hamzah Bakouni carried out the literature review, data analyses, interpreted the results, wrote the first draft of the paper, and carried out the subsequent modifications to the paper. H-M Vasiliadis conceived, designed and obtained the funding for this study. She contributed to the interpretation of the results, writing of the paper and critical review of final version.

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Correspondence to Hamzah Bakouni.

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Bakouni, H., Vasiliadis, HM. Off-Label Use of Antipsychotics and Health Related Quality of Life in Community Living Older Adults. Applied Research Quality Life 15, 991–1004 (2020). https://doi.org/10.1007/s11482-019-09718-z

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