The Alzheimer's Digest: Should people with dementia take antipsychotics?

Wednesday, October 23, 2013

Should people with dementia take antipsychotics?

Guest post by Laura Woods

Is there a risk in using antipsychotic medications for people with dementia?

Caring for an elderly person with dementia can be challenging to even the most patient caregiver. In addition to memory loss, people with dementia may hallucinate, lash out at caregivers, behave in a violent manner, and have trouble speaking.

Nursing homes often deal with these signs of agitation by treating people with dementia with antipsychotic medications including Risperdal, Zyprexa, Seroquel, and Abilify.

However, recent concerns over possible side effects, including confusion, sedation, and hastened death have raised suspicions on whether these drugs are causing more harm than good.

The American Psychiatric Association (APA) issued a statement detailing concerns that need to be addressed for elderly patients taking antipsychotic medication:

Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring.

Don’t routinely prescribe two or more antipsychotic medications concurrently.

Don’t use antipsychotics as a first choice to treat behavioral and psychological symptoms of dementia.

Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults.

Risks of atypical antipsychotics to elderly patients

In April 2005, the FDA issued a warning to healthcare professionals that patients with dementia are at an increased risk of death when treated with antipsychotic drugs. In June 2008, the agency issued a follow-up warning stating that antipsychotic drugs are not approved for the treatment of dementia-related psychosis. Physicians prescribing these drugs to patients were advised to discuss the risk of increased mortality with patients, patients’ families, and caregivers.

Not only do these medications increase the risk of deadly infection and cardiovascular complications, they can also cause dizziness, a sudden drop in blood pressure, abnormal heart rhythms, blurred vision, and urinary problems.

Antipsychotic use for elderly still strong

Despite the risk that drugs like Risperdal pose for patients with dementia, federal data indicate that approximately 185,000 nursing home residents received antipsychotics in 2010, against the recommendations of federal nursing home regulators.

More than one in five nursing homes in the United States administers antipsychotics to a substantial portion of residents, although they do not have a condition that warrants usage.

The U.S. Centers for Medicare and Medicaid (CMS) has been pushing nursing homes to decrease the use of antipsychotic drugs among elderly residents for the past two years. CMS hoped to see a 15 percent decrease by the end of 2012. Instead, from 2011 to 2013, the percentage of nursing home patients prescribed these drugs dropped by just 9 percent.