Alzheimer's, Dementia & Mental Health
Antipsychotic Drugs Appear to be Potential Killers
for Senior Citizens with Dementia
They are frequently prescribed around the time of
nursing home admission
May 27, 2008 - Older adults with dementia who
receive short-term treatment with antipsychotic medications are more
likely to be hospitalized or die than those who do not take the drugs,
according to a report in the May 26 issue of Archives of Internal
Medicine, one of the JAMA/Archives journals.
“Newer antipsychotic drugs - olanzapine (Zyprexa),
quetiapine fumarate (Seroquel)and risperidone (Risperdal) - have been on
the market for more than a decade and are commonly used to treat the
behavioral and psychological symptoms of dementia,” the authors write as
background information in the article.
(Also note report
from 2007 in sidebar on left.)
“Antipsychotic drugs are often used for short
periods to treat agitation in clinical practice. They are frequently
prescribed around the time of nursing home admission.”
About 17 percent of individuals admitted to nursing
homes are starting on antipsychotic medication within 100 days, and 10
percent receive only a single prescription. Given the widespread use of
short-term prescriptions, it is important to evaluate their safety, the
authors note.
Paula A. Rochon, M.D., M.P.H., F.R.C.P.C., of the
Institute for Clinical Evaluative Sciences (ICES), Ontario, and
colleagues studied older adults with dementia living in the community or
in nursing homes between 1997 and 2004.
In each setting, the researchers identified three
groups of equal size who were identical except for their exposure to
antipsychotic medications.
Among 20,682 older adults with dementia living in
the community,
● 6,894 did not receive antipsychotics,
● 6,894 were prescribed atypical or newer antipsychotics and
● 6,894 were prescribed conventional antipsychotics, such as
haloperidol or loxaprine.
Among 20,559 older adults with dementia living in
nursing homes,
● 6,853 received no antipsychotics,
● 6,853 received atypical antipsychotics and
● 6,853 received conventional antipsychotics.
Participants’ medical records were examined for
serious adverse events, defined as hospital admissions and death within
30 days of beginning therapy.
“Relative to community-dwelling older adults with
dementia who did not receive a prescription for antipsychotic drugs,
similar older adults who did receive atypical antipsychotic drugs were
three times more likely and those who received a conventional
antipsychotic drug were almost four times more likely to experience a
serious adverse event within 30 days of starting therapy,” the authors
write.
“Relative to nursing home residents in the control
group, individuals in the conventional antipsychotic therapy group were
2.4 times more likely to experience a serious adverse event leading to
an acute care hospital admission or death. Those in the atypical
antipsychotic group were 1.9 times more likely to experience a serious
adverse event during 30 days of follow-up.”
The analysis may underestimate the number of
adverse events because of the short length of follow-up, the authors
note.
In addition, physicians who notice early signs of a
problem may take patients off antipsychotics, avoiding more serious
consequences, and many serious events experienced by nursing home
residents are dealt with in the facility without hospital admission.
“Our results exploring serious adverse events
likely identify only the ‘tip of the iceberg’,” they write.
“Antipsychotic drugs should be prescribed with caution even for
short-term therapy.”
>> Read more
about medications used in mental illness from the National Institute of
Mental Health,
click here
