Background Antipsychotics have been associated with aspiration pneumonia in older people. However, epidemiologic evidence of the association between antipsychotic drug use and pneumonia is limited.

Purpose To investigate the association between antipsychotic exposure and aspiration pneumonia during hospitalisation in a large older population.

Material and methods Retrospective cross-sectional study. We included all hospitalisations between January 2013 and December 2017 of patients aged from 65 to 85 years. Aspiration pneumonia was defined according to the discharge diagnosis codes of the International Classification of Diseases 9 and 10 and antipsychotic use as any pharmacy charge for an antipsychotic medication.

Results Our cohort included 1 06 552 hospitalisations of patients from 65 to 85 years (medium age 74.86±10.61 years; 58% female). Aspiration pneumonia occurred in 1291 (1.2%) hospitalisations. Antipsychotics were used in 4484 (4.2%) hospitalisations. The incidence of aspiration pneumonia was 0.6% (612 patients) in patients not taking antipsychotics and 0.9% (41 patients) in those taking antipsychotics (OR=1.5, 95% CI 1.0 to 2.1). The magnitude of the association was only a little bit higher for typical (OR=1.6, 95% CI: 0.94 to 2.2) rather than atypical (OR=1.4, 95% CI: 1.0 to 2.0) antipsychotics.

Conclusion The use of either typical or atypical antipsychotics in older people is modestly associated with increased risk for aspiration pneumonia. Clinicians who prescribe antipsychotics should closely monitor patients for pneumonia, should consider the lowest possible dose of the antipsychotic for the shortest possible time and it should be stopped when the patient stabilises or symptoms cease.

References and/or acknowledgements No conflict of interest.