Medication may alleviate aggressive behavioral patterns for dementia patients but it could trigger the risk of early death, according to a new study, even more so than believed previously.
Antipsychotic drugs are prescribed for the protection of caregivers and relatives from mental patients with violent tendencies and in some cases to protect patients against themselves.
The journal JAMA Psychiatry, published the research last Wednesday online, reinforces the case against the practice of prescribing antipsychotic drugs for treatment of hallucinations, delusions, agitation and aggression, symptoms of dementia, which includes Alzheimer’s disease, the form most common.
Lead author Donovan Maust, a University of Michigan psychiatrist said, “It’s not that drugs should never be used nor does the research minimize the distress among patients and loved ones if those symptoms aren’t addressed.”
“The family can be at wit’s end,” Maust said. “A lot of times families will say, ‘If my mom or dad knew they were acting like this, they’d be mortified.’ ”
But the risks of the drugs should disclosed to providers and loved ones too.
“When you’re prescribing a medication that’s related to a harm — and that’s mortality — that’s something you really need to think about,” Maust said.
Researchers from the University of Michigan’s Medical School and VA Center for Clinical Management Research, comparing mortality death rates between patients given antipsychotic drugs for dementia against similar patient with dementia who didn’t take antipsychotic drugs, as derived from the medical records of more than 91,000 veterans over age 65.
Already, the U.S. Food and Drug Administration warn consumers of serious risk of side effects of these drugs when used in dementia patients. Researchers in the study published Wednesday likewise concluded that those taking them had a higher risk of death compared with those who did not.
The results were, patients taking haloperidol had an increased risk of dying by 3.8% compared with to those who took no antipsychotic medication. Patients taking olanzapine had a 2.5% increased risk of dying.
Valproic acid, the mood stabilizer had similar effect. Even if anti-depressants have less risk than antipsychotics and valproic acid, the risk in taking them was still higher than among those not taking psychiatric medications at all.
In 2012, 35 % older adults with dementia staying in a nursing home were prescribed an antipsychotic medication, according to a recent report by the U.S. Government Accountability Office.
About 14 percent of dementia patients outside of nursing homes were prescribed an antipsychotic medication that same year, the GAO found.
Roger Bushnell is aware of it, not only because of his parents’ dementia, but also because he hears from memory care specialists and loved ones as board chairman of the Alzheimer’s Association of Greater Michigan.
His father pitch a fit because he thought he imprisoned when nursing staff altered his dining room arrangements.
Driven by hallucinations mixed with old age memories, another nursing home resident , would accuse other staff and patients of taking her belongings.
Bushnell’s 89 mother, who has dementia and overwhelmed suddenly by emotion for no apparent reasons she can’t communicate, said Bushnell, executive director of Maple Heights Retirement Community, where his mother stays.
He said, “Sometimes it seems like the first instinct is to throw these antipsychotic drugs at the patient and hope for the best.”
There are often other alternatives. His mother is calmed with Bobby Vinton tunes. The woman who was convinced others were stealing her belongings was calmed by painting and the presence of an art therapist.
Medicare and Medicaid are not set up for easy reimbursement of providers for the hours it likely takes to assess needs and locate the best therapies. Such work is effective but can be time-consuming and costly, in part, because they don’t usually reimburse for the additional training for staff and family members either.
The National Institute of Mental Health and the National Institute on Aging funded the study.