March 2, 2012
Early Death in Nursing Homes
(Ivanhoe Newswire)-- Elderly folks ages 65 and up who are living in a nursing home and taking certain antipsychotic medications for dementia could be hastening their death.
The Harvard Medical School undertook the largest study ever among US nursing home residents, researchers looked at 75,445 older nursing home residents from 45 US states between 2001 and 2005. All nursing home residents studied were at least 65 years of age. Risks of mortality were examined over a 6 months period.The U.S. Food and Drug Administration (FDA) 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 the differing risks of each drug. This warning later included conventional antipsychotics in 2008. The authors report that despite these warnings, the use of these drugs is likely to continue because of the "continued growth of the dementia population" and the need for some type of intervention.
The study assessed death risks linked to individual antipsychotic drugs including aripiprazole, haloperidol, olanzapine, quetiapine, risperidone and ziprasidone.
Out of the 75,445 nursing home residents, a total of 6,598 died within the six month study from causes other then cancer. Patients treated with haloperidol had twice the risk of death compared with those taking risperidone, while those taking quetiapine had a less of a risk. The effect of haloperidol was strongest during the first 40 days of treatment which did not change after a dose adjustment. Almost half of deaths (49%) were recorded as due to circulatory disorders, 10% to brain disorders and 15% to respiratory disorders.
Patient characteristics were altered for age, sex, clinical condition and the presence of physical illnesses that increase risk of mortality, ethnicity, education and their location. Nursing home characteristics including facility size, occupancy rate, and availability of special care units, staffing levels, ownership, resident characteristics and quality indicators were also adjusted.
The author concluded by suggesting that not all antipsychotic medication carries the same risk of death in elderly populations. They concluded, however, that "clinicians may want to consider this evidence when evaluating“¦ the best approach to treatment of behavioral problems".
SOURCE: British Medical Journal, February 23, 2012