Objective: To assess the behavior outcomes, falls and other adverse events, and consequences of falls among patients treated with risperidone or olanzapine in LTC settings.
Materials and Methods: Patients were selected from 7,000 nursing home beds in 65 LTC facilities in New Jersey and Pennsylvania. A consultant pharmacist collected data from nurses’, primary physicians’ or psychiatrists’ notes. Outcomes included behavior outcome, ambulation status, falls, outcome of falls, adverse events (AEs), and medication to treat AEs. Statistical analyses included Chi-square, logistic regression, and Poisson regression controlling for covariates, including age, gender, and diagnoses.
Results: Data on 289 patients were collected and included in this analysis. One hundred residents received olanzapine alone, 48 olanzapine with an SSRI, 106 risperidone alone, and 35 risperidone with an SSRI. Of those, 205 (71%) were females, average age 81.1 (SD 12.3), and 84 (29%) were males, average age 72.7 (SD 12.7). The most common psychiatric diagnoses were dementia (n=171, 59%), followed by schizophrenia (n=57, 20%) and bipolar (n=22, 8%). Mean risperidone and olanzapine starting and ending doses were 1.4 mg (SD 1.7) and 1.3 mg (SD 1.5), and 5.4 mg (SD 3.9) and 6.0 mg (SD 4.7), respectively. 66 residents (63.5%) taking risperidone alone experienced an improvement on the behavior outcome, compared with 29 (30.5%) in the olanzapine alone group. Odds for behavior improvement were significantly higher with risperidone versus olanzapine (odds ratio 2.9; p<0.01). 38 residents (38%) receiving olanzapine alone and 5 (4.7%) on risperidone alone experienced one or more AEs (p < 0.01). 79 residents receiving olanzapine alone and 84 receiving risperidone alone were ambulatory; of those, 31 (39%) and 13 (15%), respectively, had at least one fall. The risk of falls was 78% less with risperidone compared to olanzapine (0.22; CI 0.06-0.51). Of the residents who fell, 4/13 (31%) receiving risperidone alone, and 14/31 (45%) receiving olanzapine alone incurred one or more injuries. A total of 8 injury events occurred in the risperidone group, versus 16 injury events in the olanzapine group.
Conclusion: In this LTC setting, use of risperidone resulted in significantly more improvements on behavior outcome, fewer AEs, and lower rate of falls compared to olanzapine. The risperidone group also experienced numerically fewer injury events than olanzapine group.
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