Despite the risk of serious side effects, antipsychotic drug prescriptions for older adults appear to be increasing as patients get older, according to a new study published in the Journal of Clinical Psychiatry.
Researchers are also concerned that among seniors who did receive an antipsychotic prescription in 2012, over 75 percent had no documented clinical psychiatric diagnosis during the year.
Furthermore, among those who did have a diagnosed mental disorder, a significant proportion of the oldest patients had dementia, regardless of FDA warnings that antipsychotics increase mortality in people with dementia.
For older adults receiving antipsychotics, there is an increased risk of dangerous side effects, including stroke, fractures, kidney injury, and mortality. Yet despite concerns, researchers found that the percentage of people receiving an antipsychotic prescription in 2010 increased with age after age 65. In fact, the number of those taking the drugs was approximately twice as high among people 80 to 84 as among those age 65 to 69.
“The results of the study suggest a need to focus on new ways to treat the underlying causes of agitation and confusion in the elderly,” said lead author Mark Olfson, M.D., M.P.H., of the Department of Psychiatry, College of Physicians and Surgeons and Columbia University and New York State Psychiatric Institute.
“The public health community needs to give greater attention to targeted environmental and behavioral treatments rather than medications.”
For the study, researchers analyzed antipsychotic prescriptions filled between 2006 and 2010 and found that among older adults who had used antipsychotics, around half had used the drugs in excess of 120 days in the year.
Among people aged 70 and older who received an antipsychotic in 2009, only around 20 percent had a recorded mental disorder or dementia diagnosis during the year. Among that 20 percent, many had a dementia diagnosis: 25 percent ages 70-74, 37 percent ages 75-79, and 48 percent ages 80-84.
“In light of these risks, the FDA has issued warnings of increased mortality regarding antipsychotics in elderly patients with dementia, particularly for ‘atypical’ (or second generation) antipsychotics,” said Michael Schoenbaum, Ph.D., senior advisor for mental health service, epidemiology and economics at NIMH.
“Nevertheless, around 80 percent of antipsychotic prescriptions among adults 65 and older were for atypical medications.”
“Typically, psychiatrists are more familiar with the properties of antipsychotic medications,” continued Schoenbaum. “However, about half of the people age 65 to 69 and only one fifth of those age 80 to 84 who were treated with antipsychotics received any of these prescriptions from psychiatrists.”