Effect of Antipsychotic Medication Use and Type on Mortality and Cardiovascular Risks in Nursing Home Patients with Dementia

Authors

Hamid R. Okhravi, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow
Fang Fang, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow
Melissa P. Hunter, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow
Brynn E. Sheehan, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow

ORCID

0009-0006-3684-5357 (Okhravi), 0000-0002-5328-8947 (Sheehan)

Document Type

Article

Publication Date

2026

DOI

10.1002/dad2.70247

Publication Title

Alzheimers & Dementia

Volume

18

Issue

1

Pages

e70247

Abstract

Introduction

Antipsychotic medication (APM) use in nursing home (NH) patients with dementia is common but carries risks. This study assessed the association between APM use and mortality, stroke, and myocardial infarction (MI) compared to non-use, as well as differences between first- and second-generation APMs.

Methods

A serial cross-sectional study using Medicare data examined outcomes from 2012 to 2015 in a national sample of 328,138 US NH residents aged 50 and older with dementia. Multivariate logistic regressions were used to analyze risk.

Results

APM use was associated with increased mortality in all years (odds ratio [OR] range: 2.39 to 1.23, all p < 0.001) and stroke risk from 2012 to 2014 (OR range: 1.17 to 1.10, p < 0.01) but not MI. First-generation APMs posed a higher mortality risk than second-generation APMs, with no significant stroke or MI differences.

Discussion

Findings highlight the need for cautious APM use in dementia patients in NHs due to elevated mortality and stroke risks.

Highlights

Study provides insights into APM risks in underrepresented nursing home (NH) dementia population. APM use in NH dementia patients is linked to higher death risk. First-generation APMs showed higher mortality risk than second-generation APMs. Overall, APM use is associated with increased stroke risk. No association was found between APM use and MI risk overall.

Rights

© 2026 The Authors.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Original Publication Citation

Okhravi, H. R., Fang, F., Hunter, M. P., & Sheehan, B. E. (2026). Effect of antipsychotic medication use and type on mortality and cardiovascular risks in nursing home patients with dementia. Alzheimers & Dementia, 18(1), Article e70247. https://doi.org/10.1002/dad2.70247

Repository Citation

Okhravi, H. R., Fang, F., Hunter, M. P., & Sheehan, B. E. (2026). Effect of antipsychotic medication use and type on mortality and cardiovascular risks in nursing home patients with dementia. Alzheimers & Dementia, 18(1), Article e70247. https://doi.org/10.1002/dad2.70247