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| Psychosis drugs risk in dementia |
3-Jun-2008 |
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By Kate Robertson
ANTIPSYCHOTICS put older adults with dementia at a greater risk of death or hospitalisation and should be prescribed with caution, researchers say.
For community-dwelling elderly people with dementia, both conventional and atypical antipsychotics were associated with a more than tripling of the risk of a serious adverse event within 30 days of initiating treatment, compared with controls, the retrospective cohort study found.
“The pattern of serious events was similar but less pronounced among older adults living in a nursing home,” the authors wrote in the Archives of
Internal Medicine (26 May).
Antipsychotics were often prescribed around the time of nursing home admission and some guidelines recommended them for short-term treatment of delirium, despite there being no RCT evidence to support this practice, they wrote.
Dr Chanaka Wijeratne, senior lecturer in the academic department for old age psychiatry at Sydney’s Prince of Wales Hospital, said the report raised concerns about the widespread use of antipsychotics in a group that was particularly susceptible to side effects.
While antipsychotics could be useful in treating symptoms such as delusions in dementia, underlying causes of agitation such as a UTI or chest infection often went untreated, he said.
“Educating carers to reassure or redirect someone who is distressed and confused, [or] soothing music or aromatherapy can be helpful.”
Many patients could be given a simple sedative such as temazepam in the short term if insomnia was the main problem, he said. Where an antipsychotic was warranted, he recommended an atypical agent (eg, Risperidone 0.25-1mg daily) titrated slowly.
Archives of Internal Medicine2008; 168:1090-96.
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