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J Clin Outcomes Manage
2010 Jan;17(1):37-46
Antipsychotic use in the elderly: overview and evidence-based management
Kales HC, Blazek M, Maisner SM, Struble LM
Abstract Objective: To present an overview of the current evidence base for the use of antipsychotics in older adults, particularly those with neuropsychiatric symptoms of dementia. Methods: Review of the literature. Results: Antipsychotics are among the most widely prescribed psychotropic drugs for the elderly population; it has been estimated that as many as 23% of older adults will experience psychotic symptoms at some point. The neuropsychiatric symptoms of dementia are one of the most common indications for which atypical antipsychotics are prescribed in the elderly, and include agitation, aggression, mood syndromes, paranoia, delusions, and hallucinations. Besides dementia, late-life syndromes with psychotic symptoms include schizophrenia, mood disorder (depression or mania) with psychosis, and delirium. The U.S. Food and Drug Administration has not approved any medication for the treatment of the neuropsychiatric symptoms of dementia, and in 2005 and 2008 warned that use of both atypical and conventional antipsychotics to treat neuropsychiatric symptoms of dementia was associated with increased mortality. Several subsequent studies highlighted the risk of antipsychotic medications in older adults in general. Conclusion: Clinicians contemplating the prescription of an antipsychotic for an elderly patient need to consider the risks and benefits of such medications with a knowledge of the current evidence base for their usage in older adults.
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