Overprescription of Antipsychotics Found in Alzheimer’s Patients, Leading to Poor Outcomes
New findings published in the Journal of the American Geriatrics Society reveal a concerning trend of overprescribing and improper use of antipsychotic drugs among patients with Alzheimer’s disease and related dementias (ADRD) who receive home health care. This misuse of antipsychotics is closely tied to worse patient outcomes.
Antipsychotic medications are not officially approved for treating dementia, but they are often prescribed off-label to manage the behavioral and psychological symptoms associated with ADRD, such as aggression, agitation, and psychosis. However, the use of antipsychotics in this context comes with significant risks of serious adverse events, including stroke and sudden cardiac death, particularly among older adults with ADRD.
Through an analysis of data from a home health care agency in New York in 2019, researchers examined the information of 6,684 adults aged 65 years and older. The study revealed that patients with ADRD were more than twice as likely to be prescribed antipsychotics compared to those without ADRD (17.2% versus 6.6%). The most commonly administered antipsychotic was quetiapine, a drug typically used for managing conditions like schizophrenia, bipolar disorder, and major depressive disorder.
Among patients living with ADRD, the use of antipsychotics was found to be associated with greater limitations in daily activities, higher medication intake, the presence of behavioral and psychological symptoms, and living alone. Additionally, it was observed that antipsychotic use correlated with less improvement in daily activities when patients were discharged from home health care.
The overuse of antipsychotics in individuals with dementia poses a serious risk to patient safety. As a result, regular review and consideration for deprescribing, such as reducing dosage until ultimately discontinuing use, should be a priority whenever possible.
Jinjiao Wang, PhD, RN and corresponding author from the University of Rochester, emphasizes the significance of addressing the use of antipsychotics in patients with dementia, stating, Antipsychotic use among older patients with dementia receiving home health care services is a prevalent issue that needs to be addressed. Deprescribing strategies should be implemented to reduce the potential harm caused by these medications.
These findings shed light on the improper prescribing practices within the realm of Alzheimer’s care and urge healthcare providers to reevaluate their approach to managing behavioral symptoms in patients with ADRD. It is crucial to prioritize patient safety and quality of care in order to improve outcomes for individuals living with Alzheimer’s disease and related dementias.
