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