A research has found that certain antipsychotic drugs meant for dementia raises death risk in elderly patients over the age of 65.
The Harvard Medical School study, the largest ever
undertaken among US nursing home residents, looked at 75,445 older nursing home
residents from 45 US states between 2001 and 2005. All nursing home residents
studied were 65 and over. Risks of mortality were looked at during a six month
The US Food and Drug Administration (FDA) warned in 2005
that atypical antipsychotic drugs are associated with an increased risk of
mortality in elderly patients with dementia, but questions still remain on
whether risks differ by drugs. This warning was expanded to include
conventional antipsychotics in 2008. The authors report that despite these warnings,
the use of these drugs is likely to continue because of the "continued growth
of the dementia population" and the need for some type of intervention.
The study assessed mortality risks associated with
individual antipsychotic drugs including aripiprazole, haloperidol, olanzapine,
quetiapine, risperidone and ziprasidone.
Out of 75,445 nursing home residents, a total of 6,598 died
within the six month study from non-cancer related causes. Patients treated
with haloperidol had double the risk of death compared with those taking
risperidone, while those taking quetiapine had a reduced risk. The effect of
haloperidol was strongest during the first 40 days of treatment which did not
change after a dose adjustment. Almost half of deaths (49%) were recorded as
due to circulatory disorders, 10% to brain disorders and 15% to respiratory
Patient characteristics were adjusted for age, sex, clinical
condition and the presence of physical illnesses that might raise risk of
mortality, ethnicity, education and geographic location (US state) as were
nursing home characteristics including facility size, occupancy rate,
availability of special care units, staffing levels, ownership, resident
characteristics and quality indicators.
In conclusion, the authors suggest that not all
antipsychotic medication carries the same risk of death in elderly populations.
They conclude, however, that "clinicians may want to consider this evidence
when evaluating [...] the best approach to treatment of behavioral problems".
In an accompanying editorial, Dr McCleery from the
Oxford NHS Foundation Trust, argues that future research should work on
identifying the key parts and efficacy of non-drug based interventions and how
these can be implemented as simply and efficiently as possible.