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   Antipsychotics For Seniors With Dementia - Death Risk   
      
   Last updated: Sat 25 Feb 2012 at 12am PST   
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   The largest Harvard Medical study, thus far, of nursing homes in the U.S.,   
   indicates in bmj.com that nursing home residents above the age of 65, who take   
   certain antipsychotic medication for dementia, have a higher risk of   
   mortality.    
      
   In 2005, the US Food and Drug Administration (FDA) issued a warning that   
   atypical antipsychotic drugs are linked to a higher risk of mortality in   
   elderly patients with dementia. However, questions still remain on whether the   
   risks vary according to which    
   drugs are taken. In 2008, the warning was extended to also include   
   conventional antipsychotics. According to the researchers, given the   
   "continued growth of the dementia population" and the need for intervention,   
   the use of these drugs tends to continue    
   despite these warnings.    
      
   Researchers examined the mortality risks associated with individual   
   antipsychotic drugs, including aripiprazole, haloperidol, olanzapine,   
   quetiapine, risperidone and ziprasidone in 75,445 older nursing home residents   
   over the age of 65 years, from 45 US    
   states, between 2001 and 2005. A risk assessment of mortality was carried out   
   during a six month period.    
      
   From all 75,445 residents, 6,598 died from non-cancer related causes within   
   the six months study. The findings revealed that residents treated with   
   haloperidol had a two-fold risk of mortality compared with those taking   
   risperidone, whilst the risk for    
   residents on quetiapine was reduced. They observed that the effect of   
   haloperidol was strongest during the first 40 therapy days, and that it did   
   not change after adjusting the dose. Nearly half of deaths (49%) were caused   
   due to circulatory disorders,    
   with 10% due to brain disorders and 15% to respiratory disorders.    
      
   Researchers adjusted both residents data and that of the nursing homes for   
   various factors, including age, sex, clinical condition and the presence of   
   physical illnesses that could potentially increase risk of mortality,   
   ethnicity, education and    
   geographic location (US state), as well as the nursing home's facility size,   
   occupancy rate, availability of special care units, staffing levels,   
   ownership, resident characteristics and quality indicators.    
      
   They concluded that the risk of mortality in the elderly varies depending on   
   the antipsychotic medication taken, however, "clinicians may want to consider   
   this evidence when evaluating [...] the best approach to treatment of   
   behavioral problems".    
      
   Dr. McCleery from the Oxford NHS Foundation Trust highlights in an   
   accompanying editorial that future research should focus on identifying the   
   key parts and efficacy of non-drug based interventions and the easiest and   
   most efficient implementation of    
   these drugs.    
      
   Written by Petra Rattue   
      
   http://www.medicalnewstoday.com/articles/242160.php   
      
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