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For Older Adults with Dementia and Behavioral Problems, Some Antipsychotic Drugs May Be Safer Than Others
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A major study of nursing home residents with dementia who were prescribed antipsychotic drugs for behavioral problems, has found that people taking some of these medications were more likely to have serious side effects than people taking other kinds of these medications.
New Research in the Journal of the American Geriatrics Society
The researchers who conducted the study were interested in whether certain antipsychotic drugs are more risky for older adults than other antipsychotic medications. It’s important to prescribe the safest drugs possible.
Many older nursing home residents with dementia have both “cognitive symptoms” – difficulty thinking and remembering – and “non-cognitive” symptoms. Non-cognitive symptoms include aggression, agitation, and wandering. Non-drug treatments such as warm baths and soothing music can help some, but not all, older people with these symptoms. When this is the case, healthcare providers may prescribe drugs. There are no medications that are approved specifically for these behavioral problems, but antipsychotic drugs are widely prescribed for these older adults. About a third of all nursing home residents take antipsychotic drugs.
Unfortunately, studies have linked antipsychotics to serious side effects, and increased risks of death, in older adults with dementia. There are two general types of antipsychotics – “conventional antipsychotics” and “atypical antipsychotics” – and both can cause dangerous side effects among older people. These side effects include problems with: heart function, movement, thinking, coordination, and alertness. These problems can contribute to potentially fatal complications such as heart attacks, falls, bone fractures, choking, infections, and pneumonia.
To learn more about whether and which antipsychotic drugs might be more likely than others to cause dangerous side effects in older adults, researchers from Harvard Medical School, Rutgers University Institute for Health, and Columbia University Medical Center studied the records of more than 83,000 adults in U.S. nursing homes. All of the adults were 65 or older, received both Medicaid and Medicare, and had started taking antipsychotic drugs after moving to a nursing home and developing dementia-related behavioral problems.
The researchers looked at the adults’ medical records over a six-month period, starting when the residents began taking the drugs. They checked whether people taking certain antipsychotic drugs were more likely to have dangerous side effects, such as infections and fractures. The researchers took care to adjust for differences in the type of patients who received one class of drugs or the other, as those differences could also affect the rate of side effects.”
The researchers found that risks of infections and, possibly, heart attacks and fractures, were higher in older adults given conventional antipsychotic drugs than those taking atypical antipsychotics. But they also found that risks of strokes were lower in those taking conventional than atypical antipsychotics.
Among atypical antipsychotic drugs there were also some differences, the researchers discovered. Patients who received some atypical antipsychotic medications had lower rates of strokes and bacterial infections, they report in the Journal of the American Geriatrics Society. The researchers also found that higher doses of the medications were generally associated with greater risks.
“The observed associations lend further support to the premise that conventional (antipsychotic drugs) are less safe than atypical (antipsychotics) in elderly adults with dementia-related behavioral symptoms and generally should not be used in this population,” the researchers conclude. “While awaiting confirmation of this finding it therefore seems prudent for clinicians to evaluate a given drug’s risk profile against an individual’s vulnerabilities when selecting a specific (antipsychotic drug) and dose and to closely monitor its safety.”
What Should I Do?
Whenever your healthcare provider prescribes a new medication ask:
- why he or she has prescribed the medication for you or a person for whom you care
- whether there are non-drug alternatives to the medication
- how you can tell whether the drug is, or isn’t, effective
- what side effects the medication may cause and what to do if they occur
- how this drug might interact with other medications, vitamins or other supplements you take or the person for whom you care takes, and how to recognize dangerous interactions
This study is from the full report titled, “Comparative Safety of Antipsychotic Medications in Nursing Home Residents.” It is in the March 2012 issue of the Journal of the American Geriatrics Society. The report is authored by Krista F. Huybrechts, MS, PhD; Sebastian Schneeweiss, MD, ScD; Tobias Gerhard, PhD; Mark Olfson, MD, MPH; Jerry Avorn, MD; Raisa Levin, MS; Judith A. Lucas, EdD, APN; and Stephen Crystal, PhD.