Avoid antipsychotic drugs for elderly, experts urge, after death risk study

Doctors should try not to prescribeantipsychotic drugsfor elderly people with Alzheimer's, geriatricians said followingnew research that concluded taking people taking the medications had double the risk of dyingduring the course of the study.

Anti-psychotic medicationsare sometimes given to control symptoms of dementia in elderly patients, such as wandering and aggressiveness. Generally, the drugs work by subduing the patients, making them easier to manage in facilities such as nursing homes.

In the study appearing in Friday's issue of the medical journal Lancet Neurology, researchers followed 165 patients in Britain aged 67 to 100 with moderate to severe Alzheimer's disease from 2001 to 2004.

Half of the participants continued taking their antipsychotic medications, including Risperdal (risperidone), Thorazine (chlorpromazine) and Stelazine (trifluoperazine). The other half got placebos.

During the three-year study, seniors given a placebo were 42 per cent less likely to die than those who stayed on anti-psychotic medications, Clive Ballard of the Wolfson Centre for Age-Related Diseases at King's College London and his colleagues said.

"I definitely think the results here are significant, and they reinforce some previous studies," said Dr. David Conn, vice-president of medical services and academic education at the Baycrest Centre for Geriatric Care in Toronto. "We definitely need to pay attention to the results."

Drug treatment needed?

Dr. Paula Rochon, vice-president of research at Women's College Hospital in Toronto, agreed, saying that she liked that the long-term study was done in a real-world setting facilities where patients were at high risk for using the therapies.

"It shows that you have to be very careful with Alzheimer's disease patients and decide if any drug treatment is necessary at all," said Rochon, adding that in situations where patients are extremely distressed or distraught, the drugs may be warranted.

Both Rochon and Conn suggested that if doctors must prescribe antipsychotics, it should be used for short periods of time, such as three months, and under careful supervision. If the person is stable at that point then doctors should try to gradually reduce the medication, Conn said.

He noted that most elderly patients do better with environmental or behavioural therapy to control behaviour such as aggression. But in many nursing homes in Europe and North America, up to 60 per cent of patients with dementia are routinely given the drugs for at least one year.

Sedating effects

Experts do not know why anti-psychotics seem to increase the risk of dying, but it's thought that the drugs could be damaging to the brain and the sedative effects may cause unsteadiness, trouble swallowing, or increase susceptibility to infections.

In the study, of the 83 receiving drugs, 39 were dead after a year. Of the 82 taking fake pills, 27 were dead after a year. Most deaths in both groups were due to pneumonia.

After two years, 46 per cent of Alzheimer's patients taking the anti-psychotics were alive, versus 71 per cent of those not on the drugs. After three years, only 30 per cent of patients on the drugs were alive, versus 59 per cent of those not taking drugs.

Between October 2002 and June 2005, Health Canada issued three warnings of increased risk of death or stroke in elderly patients with dementia who take atypical antipsychotic drugs such as risperidone. In a study published in August, researchers including Rochon concluded thatthe warnings failed to reduce the prescription rates of those drugs.

The latest study was paid for by the U.K. Alzheimer's Research Trust. Ballard reported receiving grants from pharmaceutical companies which make drugs used to treat Alzheimer's patients.