Dr. Weeks’ Comment: It is tragic that we put elderly demented people in pharmacological “straight jackets”. Is there not a better way?
Antipsychotics in Alzheimer’s Tied to Increased Morbidity
Batya Swift Yasgur, MA, LSW
RESEARCH JAMDA. Published online August 26, 2019. Abstract
October 09, 2019
Alzheimer’s disease (AD) patients who receive antipsychotics have more morbidity, as indicated by a greater number of days spent in the hospital, compared with their counterparts who were not prescribed these agents, new research shows.
During a 2-year period, AD patients taking antipsychotics had greater than 50% more accumulated hospital days than those not taking antipsychotics, with the strongest association observed during the first 6 months.
Reasons for hospitalization included psychiatric and behavioral disorders, as well as genitourinary, respiratory, and circulatory disorders, infections, and parasitic diseases.
“In this study, we found that community dwellers with Alzheimer’s disease who initiated antipsychotic use accumulated more hospital days than noninitiators, which may partially reflect adverse effects and events of antipsychotic use,” study investigator Marjaana Koponen, PhD, a postdoctoral researcher at the Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland in Kuopio, told Medscape Medical News.
“On the other hand, antipsychotic users accumulated more hospital days due to dementia, mental and behavioral disorders, and their caregivers’ days off, thus another reason for a higher accumulation of hospital days is care burden and the difficulties in treating the most severe behavioral and psychological symptoms of dementia,” she said.
The study was published online August 26 in the Journal of the American Medical Directors Organization.
Serious Adverse Event Risk
“Based on previous research, we know that antipsychotic use increases the risk of serious adverse events among person’s with Alzheimer’s disease, therefore we wanted to investigate whether antipsychotic use results in higher accumulation of hospital days in this vulnerable population,” said Koponen.
“We anticipated that this study has public health importance, as the number of people with Alzheimer’s disease is increasing worldwide and higher use of hospital care further increases the costs for society,” she added.
To investigate the question, the researchers drew on data from the nationwide register-based Medication use and Alzheimer’s disease (MEDALZ) cohort of all residents in Finland newly diagnosed with AD between 2005 and 2011, of whom 25,788 initiated antipsychotic use between AD diagnosis and December 31, 2013.
Subjects were required to be community dwelling at the time of AD diagnosis and data regarding patients’ prescriptions were extracted from the Finnish Prescription Register.
The primary study outcome was the accumulated number of hospital days during the follow-up period (2 years), with hospital days classified based on primary discharge diagnosis.
In addition, the researchers compared the accumulation of hospital days of patients prescribed the two most commonly used antipsychotics — risperidone and quetiapine.
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