The Elderly Safety Imperative and Antipsychotic Usage

Abstract

Behavioral and psychotic symptoms are common problems in older adults, and as the population ages, understanding the benefits and risks of antipsychotic usage is increasingly important. In this age group, psychotic symptoms may occur in patients with dementia or as part of schizophrenia, mood disorders, delirium, or delusional disorder. Various antipsychotics have been studied in older adults with psychotic symptoms, demonstrating mixed, but real, benefit, especially in relation to carefully selected patients. Caution is required because of the potential side effects and risks, which include increased mortality and cardiovascular and cerebrovascular events. This article reviews the use of antipsychotics in older adults, with emphasis on the risks and side effects, particularly in dementia patients with behavioral and psychotic symptoms.

Depression, Antidepressant Use and Mortality in Later Life: The Health in Men Study

“…During the years 2001–2004 those men who were still alive were contacted and invited to complete a follow-up assessment. We excluded from the present study men with a recorded history of dementia, drug abuse or dependence, psychosis or depression before 2001 – their exclusion aimed to minimize confounding associated with the past use of psychotropic agents, in particular antipsychotics [27]. These diagnoses were established by means of the Western Australian Data Linkage System (WADLS), which connects together all death records, acute hospital admissions, hospital movements, cancer registry, as well as psychiatric outpatient contacts for all residents of Western Australia since 1980 [28], [29].…”

Past exposure to neuroleptic drugs and risk of Parkinson disease in an elderly cohort

“…However, it should be noted that the more recent atypical neuroleptics are not devoid of extrapyramidal side effects, in addition to other complications in elderly people, such as cerebrovascular or cardiovascular events and mortality. 10,21 The risk of PD associated with modern atypical neuroleptics remains to be evaluated, although it may be high in the elderly according to recent data. 22 Moreover, the offending drugs in our study were not used in classic antipsychotic indications but as "hidden neuroleptics," i.e., for gastrointestinal, sleep, vertigo, or anxiety problems.…”

“…[7][8][9] Whether the drug reveals underlying PD or constitutes an independent risk factor for developing PD is not known. Neuroleptic or neuroleptic-like drugs are still widely used in the elderly, 10 and it is not known how many incident cases of PD may be attributable to or revealed by them. We thus explored the association between past use of dopamine receptor antagonists (neuroleptics, including flunarizine and cinnarizine) and the risk of subsequently developing PD in a 15-year prospective population-based cohort study of elderly people living in Southwestern France.…”

Antipsychotic Agents

“…There is evidence that antipsychotic drugs of all types are associated with increased risks of mortality in the elderly, and particularly patients with dementia, often in association with sudden death, strokes, and other cerebrovascular events [ 39,73,149,154,224 ] . Despite FDA warnings of such risks, the relative risks and potential bene fi ts of antipsychotic drug treatment in elderly, demented patients, particularly those with psychotic symptoms and severe agitation, as well as the relative contributions to risk of disease vs. treatment, continue to be debated [ 154,185 ] .…”