Senior Antipsychotic Use: The Troubling Trends

Antipsychotic medication use among elderly may increase with age

(RxWiki News) The use of antipsychotic drugs to treat elderly patients has become more common in recent years. But that may not be a good thing.

A new study from Columbia University Medical Center (CUMC) and New York State Psychiatric Institute found that the percentage of seniors treated with antipsychotic medications may increase with age — despite the known safety risks tied to these medications among older adults.

"The results of the study suggest a need to focus on new ways to treat the underlying causes of agitation and confusion in the elderly," said lead study author Mark Olfson, MD, MPH, a professor of clinical psychiatry at CUMC, in a press release. "The public health community needs to give greater attention to targeted environmental and behavioral treatments rather than medications."

Antipsychotics are a class of psychiatric medication primarily used to manage psychosis (delusions, hallucinations or disordered thought). Medications that fall within this class include clozapine (Clozaril), risperidone (Risperdal), aripiprazole (Abilify) and olanzapine (Zyprexa), among others.

For older adults, antipsychotics can increase the risk of dangerous side effects such as strokes, fractures, kidney injury and even death.

For this study, Dr. Olfson and team looked at all of the antipsychotic prescriptions filled between 2006 and 2010 in the US.

Although antipsychotics are an appropriate treatment option for certain mental conditions like schizophrenia and bipolar disorder, more than three-quarters of the seniors treated with these drugs in 2010 had no documented psychiatric diagnosis during that year. And among those who did, nearly half had dementia.

This may be cause for concern considering the recent warnings from the US Food and Drug Administration (FDA) that antipsychotics may increase mortality in dementia patients.

In 2005, the FDA warned that second-generation (atypical) antipsychotic drugs were linked to an increased risk of death in older patients with dementia. In 2008, that warning was expanded to include first-generation (conventional) antipsychotic drugs.

Around 80 percent of the antipsychotics prescribed to older adults in 2010 were found to be atypical.

The percentage of patients treated with an antipsychotic in 2010 also increased with age after age 65 — with these prescriptions about twice as likely for patients ages 80 to 84 as patients ages 65 to 69.

According to the FDA, health care professionals should consider other treatment options before antipsychotic drugs and discuss the potential health risks with the patient and/or caregivers.

Currently, there is no FDA-approved drug for the treatment of dementia-related psychosis.

This study was published Oct. 21 in the Journal of Clinical Psychiatry.

The National Institute of Mental Health funded this research. No conflicts of interest were disclosed.

Review Date: 
October 20, 2015