# Epidemiology and Risk of Antipsychotic Use in Hospitalized Elderly with Delirium

> **NIH NIH R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2020 · $530,013

## Abstract

PROJECT SUMMARY/ABSTRACT
Each year 2 million older adults receive antipsychotic medications (APMs) in the hospital, mainly for delirium.
Although the harms of APMs are well documented and their use has declined in older adults with dementia, the
scope and risk of off-label APM exposure in hospitalized older adults remain largely unknown. The objective of
this application is to determine the prescribing trends and risks of APMs and their alternatives in hospitalized
older adults with postoperative delirium. The research team will analyze data from 2 national inpatient data-
bases and detailed clinical data from 5 NIH-funded cohorts to generate evidence on the comparative safety of
APMs and their alternatives that is generalizable to real-world patients. The central hypothesis is that off-label
APM use is associated with increased risk of adverse events compared with no use in hospitalized older adults
with postoperative delirium; in particular, newer “atypical” APMs may be more harmful than conventional “typi-
cal” APM for short-term use. The applicant's preliminary data showed that, although atypical APMs may be as
harmful as typical APM in hospitalized older surgical patients, use of atypical APMs and certain psychoactive
drugs has been rising in recent years. The APM prescribing rates also vary more than 30 folds across the US
hospitals, which suggests potentially inappropriate prescribing. Lack of safety data on APMs for hospitalized
older adults, as well as little evidence on safer alternatives seems to contribute to these trends. The rationale
for this application is that the available safety data from dementia patients may not generalize to hospitalized
older surgical patients and that evidence on the comparative safety of APMs and other psychoactive drugs in
routine care patients cannot be generated from clinical trials alone. This 3-year proposal has 3 specific aims:
1) determine the risk of in-hospital mortality, institutional discharge, prolonged length of stay, and readmission
associated with different APMs in older patients with delirium after major surgery; 2) determine the risk of in-
hospital non-fatal adverse events associated with different APMs; and 3) identify psychoactive drugs that may
be prescribed as therapeutic alternatives to APMs by examining longitudinal prescribing trends. The investiga-
tors will apply innovative research methodologies of leveraging existing large claims datasets and cohort data
to enhance generalizability to routine care populations, increase statistical power to address safety for patient
subgroups and individual drugs, and reduce bias. By conducting validation of case-identification algorithms,
the investigators will improve how in-hospital adverse events are measured in inpatient drug safety research.
The impact of this research is significant, because high-quality evidence on the comparative safety of APMs
and their alternatives can guide clinicians to reduce excessive APM use and promote rationa...

## Key facts

- **NIH application ID:** 9980746
- **Project number:** 5R01AG056368-03
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Dae Hyun Kim
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $530,013
- **Award type:** 5
- **Project period:** 2018-08-01 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9980746

## Citation

> US National Institutes of Health, RePORTER application 9980746, Epidemiology and Risk of Antipsychotic Use in Hospitalized Elderly with Delirium (5R01AG056368-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9980746. Licensed CC0.

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