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Antidepressant use and mortality in very old people

Published online by Cambridge University Press:  18 March 2016

Gustaf Boström ,
Carl Hörnsten ,
Jon Brännström ,
Mia Conradsson ,
Peter Nordström ,
Per Allard ,
Yngve Gustafson  and
Håkan Littbrand
Gustaf Boström*
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Carl Hörnsten
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Jon Brännström
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Mia Conradsson
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Peter Nordström
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Per Allard
Affiliation:
Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
Yngve Gustafson
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Håkan Littbrand
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
*
Correspondence should be addressed to: Gustaf Boström, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-90187 Umeå, Sweden. Phone: +46 90 785 87 55; Fax: +46 90 13 06 23. Email: gustaf.bostrom@umu.se.
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Abstract

Background:

Antidepressant treatment may increase the risk of death. The association between antidepressants and mortality has been evaluated in community-dwelling older people, but not in representative samples of very old people, among whom dementia, multimorbidity, and disability are common.

Methods:

Umeå 85+/GERDA study participants (n = 992) aged 85, 90, and ≥95 years were followed for up to five years. Cox proportional hazard regression models were used to analyze mortality risk associated with baseline antidepressant treatment, adjusted for potential confounders.

Results:

Mean age was 89 years; 27% of participants had dementia, 20% had stroke histories, 29% had heart failure, and 16% used antidepressants. In age- and sex-adjusted analyses, antidepressant use was associated with a 76% increased mortality risk (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.41–2.19). Adding adjustment for Geriatric Depression Scale score, HR was 1.62 (95% CI, 1.29–2.03). The association was not significant when adjusting for additional confounding factors (HR = 1.08; 95% CI, 0.85–1.38). Interaction analyses in the fully adjusted model revealed a significant interaction between sex and antidepressant use (HR: 1.76; 95% CI, 1.05–2.94). Among male and female antidepressant users, the HRs for death were 0.76 (95% CI, 0.47–1.24) and 1.28 (95% CI, 0.97–1.70), respectively.

Conclusion:

Among very old people, baseline antidepressant treatment does not seem to be independently associated with increased mortality risk. However, the risk may be different in men and women. This difference and the potential risk of initial treatment require further investigation in future cohort studies of very old people.

Keywords

depressionantidepressantsage 80 and overdementiaresidential facilitiesfrail elderlyepidemiologymortality
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 7 , July 2016 , pp. 1201 - 1210
Copyright
Copyright © International Psychogeriatric Association 2016 

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