Dr. Tracy Tomac, MD, Ecumen’s consulting psychiatrist, points out three very recent studies that document the high risks for elderly patients taking antipsychotic drugs. Her summaries follow:
- Analyzing the Norwegian Prescription Database on almost 27,000 patients over 65 between 2004 and 2014, the researchers concluded that those taking antipsychotic drugs, compared with other psychotropic drugs, resulted in approximately twice the mortality risk over the short and long term. Findings suggest antipsychotics should be avoided or used with great caution. [Langhalle, et al, “Short and Long Term Mortality Risk Associated with the Use of Antipsychotics Among 26,940 Dementia Outpatients: A Population Based Study.” American Journal of Geriatric Psychiatry, April, 2014.]
- Using Veterans Health Administration data from 2010 to identify all veterans who filled a prescription for at least one psychotropic medication, researchers found that being 65 or older was the strongest predictor of being prescribed psychotropic drugs without a psychiatric diagnosis, suggesting either unnecessary use of the drugs or under diagnosis of psychiatric illness — or incomplete documentation. [Wiechers, et al, “Increased Risk Among Older Veterans of Prescribing Psychotropic Medication in the Absence of Psychiatric Diagnoses.” American Journal of Geriatric Psychiatry, April 2014.]
- In another large-scale study of VA data, patients over 65 with dementia diagnoses who were prescribed psychotropic and antidepressant drugs were matched with patients over 65 with dementia who did not take the drugs. Drugs monitored in the study were Haldol, olanzapine, quetiapine, risperidone, valproic acid and nontricyclic antidepressants. The purpose of the study was to quantify the risk of harm from each of the drugs. The riskiest drug was haloperidol (Haldol), followed in order of risk by risperidone (Risperdal), olanzapine (Zyprexa), valproic acid (Depakote) and quetiapine (Seroquel). The antidepressant risk of harm was judged to be very low and not clinically irrelevant. [Dr. Donovan T. Maust, presentation at the March 2014 American Association for Geriatric Psychiatry.]
Meanwhile, according to new trend research by Centers for Medicare and Medicaid services, over 18 months, the national prevalence of antipsychotic use in long-stay nursing home residents was reduced by 15.1% (the prevalence rate decreased from 23.8% to 20.2%) and every CMS region showed at least some improvement. While that is promising much more work needs to be done by providers.