A study by the Harvard Medical School published this week has again highlighted the risks of using antipsychotic medication for people with dementia. The researchers found some individual antipsychotic drugs significantly increase the risk of death in nursing home residents aged over 65. K F Huybrechts, instructor in medicine and his team, reviewed 75,445 nursing home residents in 45 US States between 2001 and 2005 who had been prescribed individual antipsychotic medications. They found that some of the drugs were associated with higher mortality rates.
With up to a third of all elderly patients in nursing homes being treated with antipsychotic drugs, their use remains a significant health issue. The Food and Drug Administration (FDA) already warns that their use in people with dementia is not indicated but their efficacy in closely monitored elders with psychosis and acute behavioral problems means the drugs can still be a valuable treatment tool.
The research, published on bmj.com, looked at new users of the antipsychotic drugs haloperidol, aripiprazole, olanzapine, quetiapine, risperidone and ziprasidone. Out of the 75,445 nursing home residents all of whom were eligible for Medicaid, a total of 6,598 (8.7 per cent) died within the six month study from non-cancer related causes. They found that patients treated with haloperidol had double the risk of death than people taking risperidone. The drug quetiapine was the drug least associated with the risk of death. They found that olanzapine, risperidone, ziprasidone, aripiprazole showed ‘no clinically meaningful differences.'
Deaths were strongest shortly after the start of treatment and were more marked when higher doses of the drugs were used. Almost half of deaths (49%) recorded were due to circulatory disorders, 10% to brain disorders and 15% to respiratory disorders.
The Harvard Medical School team conclude that their findings cannot prove causality but that they do provide more evidence on the risks on using the drugs in older people with haloperidol being the drug most associated with death.
What do these findings mean for caregiver to people with Alzheimer's? It means we have a significant role to help nursing and medical staff monitor for changes if our loved ones are prescribed these drugs for significant behavioral problems associated with psychosis. Side effects can be a problem so it is good to know what to look out for, this guide to antipsychotic drug side effects and Alzheimer's can help. When a loved one requires nursing home care our role as advocate comes into play. We know from previous shareposts, such as the FDA warning doctors antipsychotics risky for elderly people, that they do have problems, but sometimes their careful use can have a very positive outcome in some people with Alzheimer's and other types of dementia.