A new study published in the Journal of the American Geriatrics Society raises concerns about the overprescription of antipsychotic drugs in patients with Alzheimer’s disease and related dementias (ADRD) who are under home health care.
Antipsychotic drugs are not approved for treating dementia but are often used off-label for managing behavioral symptoms.
The study found that such usage is linked to worse outcomes and carries significant risks, especially among older adults.
The study examined the medical records of 6,684 adults aged 65 and older who were receiving care from a home health care agency in New York in 2019.
Researchers found that 17.2% of patients with ADRD were prescribed antipsychotics, compared to just 6.6% among those without ADRD. The most commonly used antipsychotic was quetiapine.
Risk Factors for Antipsychotic Use in ADRD Patients
Limitations in daily activities: Patients with greater limitations were more likely to be prescribed antipsychotics.
Polypharmacy: Those taking more medications had higher rates of antipsychotic prescriptions.
Behavioral symptoms: Patients showing symptoms like agitation and aggression were more likely to receive antipsychotics.
Living alone: Being alone was also identified as a risk factor for antipsychotic use.
Negative Outcomes Linked to Antipsychotic Use
Patients with ADRD who were prescribed antipsychotics were found to have less improvement in daily activities upon discharge from home health care.
Antipsychotics carry serious risks, including a higher likelihood of stroke and sudden cardiac death among older adults with ADRD.
Implications and Recommendations
Jinjiao Wang, Ph.D., RN, from the University of Rochester, who was the corresponding author of the study, described the use of antipsychotics in dementia patients as a “serious patient safety issue.”
Wang recommends regular reviews of antipsychotic prescriptions in these patients, with the aim of reducing dosage and eventually discontinuing the drugs wherever possible.
The study suggests a need for alternative approaches to manage the behavioral symptoms in ADRD patients, especially for those in home health care settings.
It also calls for greater scrutiny and oversight of antipsychotic prescriptions for older adults, particularly those with ADRD.
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The research findings can be found in the Journal of the American Geriatrics Society.
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