Study: Antipsychotics increase mortality in nursing home residents with dementia

Nursing home residents over the age of 65 who take certain antipsychotic medication for dementia are at an increased risk of death, according to a research paper published at bmj.com.

The Harvard Medical School study, which researchers said was the largest ever undertaken among U.S. nursing home residents, looked at 75,445 older nursing home residents from 45 states between 2001 and 2005. All nursing home residents studied were 65 and older.

This current study, which was conducted during a six-month period in the larger Harvard Medical Study, assessed mortality risks associated with individual antipsychotic drugs including aripiprazole, haloperidol, olanzapine, quetiapine, risperidone and ziprasidone.

A total of 6,598 nursing home residents had 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, researchers said.

The effect of haloperidol was strongest during the first 40 days of treatment that did not change after a dose adjustment. Almost half of deaths (49 percent) were recorded as due to circulatory disorders, 10 percent to brain disorders and 15 percent to respiratory disorders.

The US Food and Drug Administration 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 Harvard researchers said that despite these warnings, the use of antipsychotics in treating nursing home residents with dementia is likely to continue because of the "continued growth of the dementia population" and the need for some type of intervention.

Researchers suggested that not all antipsychotic medication carries the same risk of death in elderly populations, but that "clinicians may want to consider this evidence when evaluating […] the best approach to treatment of behavioral problems."

The American Health Care Association recently announced in a new quality initiative that it would like its member facilities to reduce the off-label use of antipsychotics in their residents by 15 percent by December 2012.

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