Effect of discontinuing antipsychotic medications on the risk of hospitalization in long-term care: a machine learning-based analysis
Abstract Background Antipsychotic medications are frequently prescribed to older residents of long-term care facilities (LTCFs) despite their limited efficacy and considerable safety risks. While discontinuation of these drugs might help reduce their associated morbidity, the impact of stopping anti...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-08-01
|
| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-025-04304-7 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849226228876181504 |
|---|---|
| author | Mikko Nuutinen Riikka-Leena Leskelä Daniela Fialova Ira Haavisto Harriet Finne-Soveri Jokke Häsä Johanna Edgren Hein van Hout Daniel E. da Cunha Leme John P. Hirdes Graziano Onder Rosa Liperoti |
| author_facet | Mikko Nuutinen Riikka-Leena Leskelä Daniela Fialova Ira Haavisto Harriet Finne-Soveri Jokke Häsä Johanna Edgren Hein van Hout Daniel E. da Cunha Leme John P. Hirdes Graziano Onder Rosa Liperoti |
| author_sort | Mikko Nuutinen |
| collection | DOAJ |
| description | Abstract Background Antipsychotic medications are frequently prescribed to older residents of long-term care facilities (LTCFs) despite their limited efficacy and considerable safety risks. While discontinuation of these drugs might help reduce their associated morbidity, the impact of stopping antipsychotics on the risk of hospitalization has not been studied yet. The study aimed at estimating the effect of antipsychotic discontinuation on the risk of hospitalization in older LTCF residents and at identifying relevant factors influencing such effect. Methods For this registry-based retrospective cohort study, data from a cohort of older LTCF residents in Finland from the years 2014 to 2018 was analyzed. Data sources were the Resident Assessment Instrument for Long-Term Care (RAI-LTC) based comprehensive geriatric assessments and the Finnish Care Register for Health Care. For the initial cohort, 5467 users of antipsychotic medications with at least four assessments, each conducted 6 months apart, were selected. Residents were defined either as discontinuing, if antipsychotics were prescribed at the first two assessments but not at the last two, or as chronic users, if antipsychotics were prescribed at all four assessments. Causal machine learning (ML) methods including double machine learning (DML), double robust (DR), X-learner, and causal forest (CF) were applied to estimate the effect of antipsychotic discontinuation on the risk of hospitalization and to identify factors influencing such effect. The follow-up time was 1 year. The methods of SHAP values (SHapley Additive exPlanations), partial dependence plots (PDP), and surrogate models were used for model interpretation. Results Nearly 43% of residents in the study discontinued antipsychotic medications. Antipsychotic discontinuation lowered the probability of hospitalization of about 12% (average treatment effect, ATE). The individual treatment effect (ITE) estimations ranged from − 30% to + 1%. The use of restraints, age, and functional impairment were relevant variables in all ITE models in influencing the predicted ITE. Conclusions Antipsychotic discontinuation may decrease the likelihood of hospitalization among older LTCF residents, benefiting most users of these drugs. Promoting antipsychotic discontinuation may prevent hospitalizations and reduce morbidity and mortality in long-term care. |
| format | Article |
| id | doaj-art-a3a13c4e608f445bb72df64003c7ee7f |
| institution | Kabale University |
| issn | 1741-7015 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj-art-a3a13c4e608f445bb72df64003c7ee7f2025-08-24T11:34:01ZengBMCBMC Medicine1741-70152025-08-0123111210.1186/s12916-025-04304-7Effect of discontinuing antipsychotic medications on the risk of hospitalization in long-term care: a machine learning-based analysisMikko Nuutinen0Riikka-Leena Leskelä1Daniela Fialova2Ira Haavisto3Harriet Finne-Soveri4Jokke Häsä5Johanna Edgren6Hein van Hout7Daniel E. da Cunha Leme8John P. Hirdes9Graziano Onder10Rosa Liperoti11Nordic Healthcare GroupNordic Healthcare GroupDepartment of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles UniversityNordic Healthcare GroupFinnish Institute for Health and WelfareFinnish Institute for Health and WelfareFinnish Institute for Health and WelfareVUMC – University Medical Center AmsterdamSchool of Public Health Sciences, University of WaterlooSchool of Public Health Sciences, University of WaterlooUniversità Cattolica del Sacro CuoreUniversità Cattolica del Sacro CuoreAbstract Background Antipsychotic medications are frequently prescribed to older residents of long-term care facilities (LTCFs) despite their limited efficacy and considerable safety risks. While discontinuation of these drugs might help reduce their associated morbidity, the impact of stopping antipsychotics on the risk of hospitalization has not been studied yet. The study aimed at estimating the effect of antipsychotic discontinuation on the risk of hospitalization in older LTCF residents and at identifying relevant factors influencing such effect. Methods For this registry-based retrospective cohort study, data from a cohort of older LTCF residents in Finland from the years 2014 to 2018 was analyzed. Data sources were the Resident Assessment Instrument for Long-Term Care (RAI-LTC) based comprehensive geriatric assessments and the Finnish Care Register for Health Care. For the initial cohort, 5467 users of antipsychotic medications with at least four assessments, each conducted 6 months apart, were selected. Residents were defined either as discontinuing, if antipsychotics were prescribed at the first two assessments but not at the last two, or as chronic users, if antipsychotics were prescribed at all four assessments. Causal machine learning (ML) methods including double machine learning (DML), double robust (DR), X-learner, and causal forest (CF) were applied to estimate the effect of antipsychotic discontinuation on the risk of hospitalization and to identify factors influencing such effect. The follow-up time was 1 year. The methods of SHAP values (SHapley Additive exPlanations), partial dependence plots (PDP), and surrogate models were used for model interpretation. Results Nearly 43% of residents in the study discontinued antipsychotic medications. Antipsychotic discontinuation lowered the probability of hospitalization of about 12% (average treatment effect, ATE). The individual treatment effect (ITE) estimations ranged from − 30% to + 1%. The use of restraints, age, and functional impairment were relevant variables in all ITE models in influencing the predicted ITE. Conclusions Antipsychotic discontinuation may decrease the likelihood of hospitalization among older LTCF residents, benefiting most users of these drugs. Promoting antipsychotic discontinuation may prevent hospitalizations and reduce morbidity and mortality in long-term care.https://doi.org/10.1186/s12916-025-04304-7Antipsychotic medicationsLong-term careMachine learning |
| spellingShingle | Mikko Nuutinen Riikka-Leena Leskelä Daniela Fialova Ira Haavisto Harriet Finne-Soveri Jokke Häsä Johanna Edgren Hein van Hout Daniel E. da Cunha Leme John P. Hirdes Graziano Onder Rosa Liperoti Effect of discontinuing antipsychotic medications on the risk of hospitalization in long-term care: a machine learning-based analysis BMC Medicine Antipsychotic medications Long-term care Machine learning |
| title | Effect of discontinuing antipsychotic medications on the risk of hospitalization in long-term care: a machine learning-based analysis |
| title_full | Effect of discontinuing antipsychotic medications on the risk of hospitalization in long-term care: a machine learning-based analysis |
| title_fullStr | Effect of discontinuing antipsychotic medications on the risk of hospitalization in long-term care: a machine learning-based analysis |
| title_full_unstemmed | Effect of discontinuing antipsychotic medications on the risk of hospitalization in long-term care: a machine learning-based analysis |
| title_short | Effect of discontinuing antipsychotic medications on the risk of hospitalization in long-term care: a machine learning-based analysis |
| title_sort | effect of discontinuing antipsychotic medications on the risk of hospitalization in long term care a machine learning based analysis |
| topic | Antipsychotic medications Long-term care Machine learning |
| url | https://doi.org/10.1186/s12916-025-04304-7 |
| work_keys_str_mv | AT mikkonuutinen effectofdiscontinuingantipsychoticmedicationsontheriskofhospitalizationinlongtermcareamachinelearningbasedanalysis AT riikkaleenaleskela effectofdiscontinuingantipsychoticmedicationsontheriskofhospitalizationinlongtermcareamachinelearningbasedanalysis AT danielafialova effectofdiscontinuingantipsychoticmedicationsontheriskofhospitalizationinlongtermcareamachinelearningbasedanalysis AT irahaavisto effectofdiscontinuingantipsychoticmedicationsontheriskofhospitalizationinlongtermcareamachinelearningbasedanalysis AT harrietfinnesoveri effectofdiscontinuingantipsychoticmedicationsontheriskofhospitalizationinlongtermcareamachinelearningbasedanalysis AT jokkehasa effectofdiscontinuingantipsychoticmedicationsontheriskofhospitalizationinlongtermcareamachinelearningbasedanalysis AT johannaedgren effectofdiscontinuingantipsychoticmedicationsontheriskofhospitalizationinlongtermcareamachinelearningbasedanalysis AT heinvanhout effectofdiscontinuingantipsychoticmedicationsontheriskofhospitalizationinlongtermcareamachinelearningbasedanalysis AT danieledacunhaleme effectofdiscontinuingantipsychoticmedicationsontheriskofhospitalizationinlongtermcareamachinelearningbasedanalysis AT johnphirdes effectofdiscontinuingantipsychoticmedicationsontheriskofhospitalizationinlongtermcareamachinelearningbasedanalysis AT grazianoonder effectofdiscontinuingantipsychoticmedicationsontheriskofhospitalizationinlongtermcareamachinelearningbasedanalysis AT rosaliperoti effectofdiscontinuingantipsychoticmedicationsontheriskofhospitalizationinlongtermcareamachinelearningbasedanalysis |