Association between antipsychotics and adverse outcomes in dementia

Bangash, Ayesha; Stubbs, Rebecca W.; Khan, Farooq; Samnani, Sheliza; Aziz, Humaira; Mitra, Madhumanti

doi:10.1002/pnp.482

Cited by 9 publications

(5 citation statements)

References 21 publications

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“…Most of the results from the SUCRA ranking are congruent with published observational studies. For example, previous reports corroborate ranking quetiapine as the safest and risperidone as the least safe based on EPSs . Quetiapine was ranked as most likely to cause somnolence or sedation, which might explain why it is commonly used as a sedative-hypnotic in patients with dementia .…”

Section: Discussionmentioning

confidence: 66%

“…For example, previous reports corroborate ranking quetiapine as the safest and risperidone as the least safe based on EPSs. 65 , 66 Quetiapine was ranked as most likely to cause somnolence or sedation, which might explain why it is commonly used as a sedative-hypnotic in patients with dementia. 67 The ranking results for somnolence or sedation are similar to those of death and may be explained by the fact that excessive sedation or sleep is associated with infection, including pneumonia, which could ultimately lead to death.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of Reported Comparative Effectiveness and Safety of Atypical Antipsychotics in the Treatment of Behavioral and Psychological Symptoms of Dementia

et al. 2019

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Key Points Question Which atypical antipsychotic is most beneficial and safe for the treatment of behavioral and psychological symptoms of dementia? Findings In this network meta-analysis of 17 studies (5373 patients), no significant differences were found across measures of effectiveness and safety among aripiprazole, olanzapine, quetiapine, and risperidone, although differences were found for some of these drugs and outcomes compared with placebo. No trials were found for other atypical antipsychotics. Meaning Insufficient evidence exists on which atypical antipsychotic is both safest and most beneficial across several measures for people with dementia, and this study suggests that a single most effective and safe treatment option may not exist.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Assessment of Reported Comparative Effectiveness and Safety of Atypical Antipsychotics in the Treatment of Behavioral and Psychological Symptoms of Dementia

et al. 2019

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“…Over half of the settings that received a psychotropic medication citation had an MC endorsement. This is expected, given higher psychotropic medication use among individuals with an ADRD diagnosis (Bangash et al, 2017;Mueller et al, 2021). A seven-state study of 250 AL/RC communities prescribing and administration of PRN psychotropic medications found that prescribing was higher among residents with a dementia diagnosis and in settings that were larger and had more dementia care beds (Carder et al, 2022).…”

Section: Discussionmentioning

confidence: 98%

“…A significant share of assisted living/residential care (AL/RC) settings residents have Alzheimer’s disease or related dementia (ADRD) (42%), and an estimated 26–90% have cognitive impairment (Sengupta et al, 2022; Zimmerman et al, 2014). Psychotropic medication used to manage symptoms and behaviors associated with ADRD, including AL/RC residents (Maust et al, 2018; Thomas et al, 2021), presents a significant health policy concern because of their associations with adverse events (e.g., falls, mortality) and care provision implications (Bangash et al, 2017; Beeber et al, 2021; Crystal et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Paperwork, Paradox, and PRN: Psychotropic Medication Deficiencies in Assisted Living

Dys

Carder

2023

J Appl Gerontol

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Individual state approaches to assisted living/residential care (AL/RC) licensing and oversight in the United States result in different practice standards and requirements, including psychotropic medication use. We examined 170 psychotropic medication deficiency citations issued to 152 Oregon AL/RC settings from 2015 to 2019. Applied thematic analysis resulted in the following themes: (1) documentation issues are primarily responsible for noncompliance, (2) unclear parameters place direct care workers in a role paradox, and (3) there is a persistent disconnect about when to seek qualified expertise before requesting psychotropic medications. AL/RC-specific mechanisms for medication prescription and administration are necessary to improve the structure and processes of care. Policymakers might consider how regulations unintentionally incentivize task-oriented versus person-centered care practices.

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“…Partial tolerance develops with ongoing use, although this develops slowly. An increased risk of falls and hip fractures still occurs in chronic users of sedatives, increased risk also seen with patients using tricyclic antidepressants and antipsychotic medications …”

Section: Adverse Effects Of Medications Commonly Used For Sleep Disormentioning

confidence: 99%

Treatment of sleep disturbance in older adults

Reynolds

Adams

2019

Pharmacy Practice and Res

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Sleep and circadian rhythm disturbances are prevalent in older populations. Numerous factors can affect sleep, including medications, living environment and physical, mental and psychosocial factors (e.g. loneliness and stress). Sleep architecture changes with aging, with less deep sleep (slow wave sleep) and an increased frequency of awakenings after sleep onset. Benzodiazepines, Z-drugs and low doses of the tricyclic antidepressant doxepin have modest positive benefits for sleep complaints, but side effects are a concern in older people because they include an increased risk of falls, fractures and cognitive impairment. Somnolence can be prolonged in older adults. Melatonin has very modest effects on sleep initiation in older adults, although appears safe. Overall, the effects of pharmacological treatments are modest and there are concerns about the efficacy and safety of their ongoing use. There is strong evidence for non-pharmacological interventions, including cognitive and behavioural strategies, to improve sleep. These have at least comparable efficacy to pharmacological interventions, fewer adverse effects and are more likely to have longer-term, sustained benefits. Sleep complaints in older adults need to be approached on a patient-by-patient basis, and medication should be reviewed frequently, with preference to limit pharmacological intervention as far as practicable.

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Association between antipsychotics and adverse outcomes in dementia

Cited by 9 publications

References 21 publications

Assessment of Reported Comparative Effectiveness and Safety of Atypical Antipsychotics in the Treatment of Behavioral and Psychological Symptoms of Dementia

Assessment of Reported Comparative Effectiveness and Safety of Atypical Antipsychotics in the Treatment of Behavioral and Psychological Symptoms of Dementia

Paperwork, Paradox, and PRN: Psychotropic Medication Deficiencies in Assisted Living

Treatment of sleep disturbance in older adults

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