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Short-term
use of antipsychotics in Older Adults with
Dementia linked to serious adverse events
Newswise — Older adults with dementia who
receive short-term courses of 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,
quetiapine fumarate and risperidone) 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.
“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.”
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