When agitated dementia patients wander or shout through the night, families and caregivers understandably feel the need to treat this frightening and potentially dangerous behavior. Antipsychotic medications are often resorted to with such patients, contributing to increases in antipsychotic treatment rates among older people.
Indeed, a research letter by Rutgers and Columbia University researchers in JAMA Psychiatry shows those prescriptions are becoming more common in the United States, even though antipsychotic drugs do little for dementia and carry a black-box warning on their labels stating they increase the risk of death in senior patients.
Using a national prescription-claims database that captures more than 90% of retail pharmacy fills, researchers tracked antipsychotic use among adults 65 and older from 2015 through 2024 and found that the annual rate of any antipsychotic use increased nearly 52% to 4.05 per 100 from 2015 to 2024. Long-term use, defined as at least 120 days a year, rose 65%, to 2.45 per 100 older adults. Rates were highest among people 75 and older, rising from 3.42 to 5.12 per 100.
The trend is striking because antipsychotics have limited proven effectiveness in people 65 and older and come with serious risks, including falls, fractures, cardiovascular and cerebrovascular events, pulmonary embolism and death. Antipsychotics may be used as a last resort to manage severe behavioral and psychological symptoms of dementia, such as aggression, agitation, hallucinations, or delusions, especially when these symptoms pose a risk to the safety of the individual or others. However, such use carries substantial risk and should be avoided in most cases and limited to short-term use whenever possible. To read the full story.