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Antipsychotics and Oropharyngeal Dysphagia in Hospitalized Older Patients

Rudolph, James L. MD, SM*†‡; Gardner, Kelly F. MS§; Gramigna, Gary D. MS§; McGlinchey, Regina E. PhD*‡

Journal of Clinical Psychopharmacology: October 2008 - Volume 28 - Issue 5 - p 532-535
doi: 10.1097/JCP.0b013e318184c905
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In the inpatient setting, dysphagia is a common, morbid, and costly condition. Antipsychotic medications in older patients have been associated with dysphagia. The purpose of this study was to determine if hospitalized patients who were exposed to antipsychotic medications had worse swallowing function than those who were not exposed. Retrospectively, all patients referred for swallowing difficulty who underwent a videofluoroscopic swallowing study during the course of their hospital care were considered eligible. We excluded patients younger than 50 years and those with a history of dysphagia, a medical cause for dysphagia, or chronic antipsychotic medication usage. Patients exposed to antipsychotics (n = 17) were matched at a 3:1 ratio to patients without exposure (n = 51) for age, comorbidity, and anticholinergic risk. Videofluoroscopic swallowing study was scored according to the Dysphagia Severity Rating Scale (range, 0-6; 6 = worst). Patients who were given antipsychotic medications scored significantly worse on the Dysphagia Severity Rating Scale compared with matched controls (4.1 ± 1.0 vs 3.0 ± 1.4; P < 0.01). Using the medication and dosage, the antipsychotic exposure was quantified by converting to chlorpromazine equivalency units. Higher doses of antipsychotic medication were associated with worse swallowing function (P = 0.04). Thus, the potential impact on swallow functions should be considered when prescribing antipsychotic medications in older patients.

*Geriatric Research Education and Clinical Center, VA Boston Healthcare System; †Division of Aging, Brigham and Women's Hospital; ‡Harvard Medical School; and §Department of Audiology/Speech Pathology, VA Boston Healthcare System, Boston, MA.

Received March 18, 2008; accepted after revision June 26, 2008.

Dr Rudolph is supported by a VA Rehabilitation Research Career Development Award. Dr McGlinchey is supported by a VA Merit Review and NIAAA R01 1405.

Address correspondence and reprint requests to James L. Rudolph, MD, SM, VA Boston Healthcare System GRECC (JP-182), 150 South Huntington Ave, Boston, MA 02130. E-mail: jrudolph@partners.org.

© 2008 Lippincott Williams & Wilkins, Inc.