Short Term Use of Antipsychotic Drugs in Older People with Dementia Riskyby Christine Kennard Health Professional
It is estimated that 3-10 percent of all hospital admissions for elderly patients are due to adverse drug reactions. Thirty percent of all prescribed drugs in the US are taken by people over the age of 65 years and it is projected that by the year 2030 that will rise to 40 percent. Over 90 percent of people over the age of 65 yrs take at least one drug, mostly two and a few take many more.
Most recently it has been reported that older people with dementia who receive short courses of antipsychotic (neuroleptic) medications are more likely to die or be hospitalized than those not taking the drugs. Those are the findings of Paula A Rochon, MD., and her colleagues at the Institute for Clinical Evaluative Sciences (ICES) in Ontario.
Also read this related news article on the risks of using antipsychotics in treating elderly patients with dementia.
The researchers found a community based study group taking atypical antipsychotics were three times more likely than those taking no antipsychotic medication to have a serious adverse event, and those taking conventional antipsychotics were even more at risk with a four times more likely to experience an adverse event. People in nursing homes did slightly better, probably because staff were more likely to observe adverse reactions quicker and therefore took action, such as discontinuing medication. Their residents taking atypical antipsychotics were 1.9 times more likely to experience a serious adverse event with those taking conventional antipsychotics again more at risk in a 2.4 risk factor.
This study follows previous findings that caution against the misuse of antipsychotic medication in older people with dementia. Antipsychotic medications are powerful drugs. As well as having a tranquilizing effect, this group of drugs can also have an antipsychotic or normalizing effect on behavior. Their use can be very helpful to the patient and to caregivers in the control of some of the very difficult behaviors that people with Alzheimer's exhibit. The aim of using this group of medications are to reduce or relieve symptoms. They can be used to help with hallucinations and paranoid behavior, to tranquilize but not impair consciousness, to help an individual think more clearly and to improve quality of life. They are also used to improve sleep. It is important to remember that these medications cannot work in isolation and are not alternatives to other therapeutic activities. Medication should just be one part of a comprehensive treatment plan.
Reporting in the May 26 issue of the Archives of Internal Medicine, Dr Rochon's team studied over 40,000 older adults with dementia who between 1997 and 2004 lived in nursing homes or in the community. The researchers looked in the participants medical notes for serious adverse events, hospital admission or death within the first 30 days from the beginning of antipsychotic drug therapy. Of the sample living in the community 6,894 did not receive antipsychotics, 6,894 received conventional antipsychotics such as chlorpromazine (largactil), haloperidol (Haldol, Serenace) or loxaprine , and 6,894 were prescribed the newer type of atypical antipsychotics such as olanzapine (Zyprexa), quetiapine (Seroquel) or clozapine (Clozaril). Amongst the 20,559 nursing home residents with a diagnosis of dementia divided into 3 equal groups, 6,853 received no antipsychotics, 6,853 received conventional antipsychotics and 6,853 received atypical antipsychotics.
Remember tranquilizers, except in extraordinary or emergency circumstances, should never be used as a chemical restraint. Challenging behaviors or problem behaviors exhibited by someone with Alzheimer's often require the help of experts in that field. Using this type of medication is just one way of improving the life of someone with Alzheimer's and their caregivers.
Source: Archives of Internal Medicine. 2008;168:1090-1096.