A new study found that elderly patients who stop taking antipsychotic drugs (after receiving them for behavioral control in the hospital) have better outcomes than those who continue taking the drugs. Those who discontinued antipsychotics (APMs) had lower rates of rehospitalization, delirium, dangerous falls, urinary tract infections, and death.
“These findings underscore the importance of reevaluating the need for ongoing APM use and support the use of APMs for the shortest possible duration to minimize potential harms,” the researchers write.
The researchers write that older adults often end up prescribed APMs as a form of behavioral control in the hospital, used off-label (without FDA approval) “to manage acute behavioral disturbances or hyperactive delirium.” They note that this is common, with up to 41% of those with dementia (and 10.2% of those without) receiving these drugs in the hospital. However, the researchers note that there is no evidence supporting the use of these drugs for this indication.
“APMs are frequently prescribed for off-label use to manage acute behavioral disturbances or hyperactive delirium in hospitalized older patients,” they write. “To our knowledge, there is currently no consistent evidence supporting the efficacy of APM use in addressing behavioral disturbances.”
The researchers also note the many dangers of antipsychotic drug use in the elderly.
“APMs are linked to several adverse clinical outcomes, including death, falls and fractures, pneumonia, urinary tract infection, and stroke,” they write.
The study was led by Chun-Ting Yang at Brigham and Women’s Hospital and Harvard Medical School, Boston, and published in JAMA Psychiatry.
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This gives the impression that antipsychotics are mostly prescribed by hospitals. That is not my experience. Nursing homes, assisted living facilities, and adult foster homes very commonly prescribe these drugs for “behavior management.” I’m not surprised that they don’t really work and create bad outcomes. But do you think this will change the behavior of those handing out these prescriptions like candy? I don’t think it will. They are not operating on scientific data.
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Ten years ago, it was illegal to prescribe off label chemical restraint.
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