Dementia Antipsychotics Death Risk Higher Than Previously Thought: Study

Researchers from the University of Michigan indicate that use of antipsychotic medications like Risperdal and Seroquel among patients with dementia may be even more dangerous than previously believed, increasing the risk of death over the subsequent months. 

A study published this month in the medical journal JAMA Psychiatry indicates that the dementia antipsychotics death risk appears to increase with dose, particularly men newer medications and those that include the same active ingredient as the antiseizure drug Depakote are used.

Although there has been a known risk of death associated with antipsychotic use among the elderly, the medications continue to be used as a form of chemical restraint in nursing homes, sedating dementia residents that are difficult to manage.

In this latest study, researchers looked at data on nearly 91,000 veterans age 65 and older with dementia from October 1, 1998 to September 30, 2009. The study looked at the effects on subjects given the drugs Risperdal, Seroquel, Haldol, Zyprexa, and drugs that are based on valproic acid, such as Depakote, Depacon, Depakene and Stavzor.

Researchers examined the risk of death over the next 180 days after the elderly individuals were prescribed the drugs, finding that use of the medications were associated with an overall 3.5% increased risk of mortality. That risk was dose-specific, meaning the higher the dose, the higher the risk of death. Antidepressants also appeared to increase the risk of death, but not to as strong a degree as antidepressants and valproic acid.

The FDA has previously warned against the use of antipsychotics with dementia patients, indicating that the medications provide no benefits and may increase the risk of death. Given what is known about the potential side effects of antipsychotics, use of the medications is often considered a form of elderly abuse when the purpose is to sedate the individual, rather than treat.

The Department of Health and Human Services (HHS), in conjunction with other federal agencies and private groups, is already battling antipsychotic drug use in nursing homes through the National Partnership to Improve Dementia Care and other efforts.

In September 2014, the National Partnership to Improve Dementia Care announced that it has set a goal of reducing the use of antipsychotics in long-term care facilities by 25% before the end of 2015. The group hopes to see reductions of 30% by the end of 2016.

“The harms associated with using these drugs in dementia patients are clear, yet clinicians continue to use them,” lead study author Dr. Donovan Maust, a University of Michigan and Veterans Affairs psychiatrist said in a press release. “That’s likely because the symptoms are so distressing. These results should raise the threshold for prescribing further.”

Researchers called for clinicians to look at non-pharmacological strategies first when treating dementia symptoms. However, they said the approach takes more time than writing a prescription and that whether doctors go that route will depend on reimbursement strategies and the actions of policy-makers.

The findings come days after a report by the U.S. Government Accountability Office (GAO), which found that too many elderly patients both in nursing homes and being treated at home are still being prescribed antipsychotics despite the FDA’s warnings that they do little to help and increase the risk of death.

The GAO report found that patient agitation, delusions, and certain setting-specific characteristics led to the use of antipsychotics as chemical restraints. The report found that the lower nursing home staff levels are, the higher the likelihood of unnecessary antipsychotic prescriptions to dementia patients.

The Department of Justice (DOJ) has previously accused Johnson & Johnson of engaging in kickback schemes designed to convince doctors to prescribe their antipsychotic medication Risperdal to elderly nursing home patients, knowing that the drug was being used abusively and potentially placing patients’ at risk of death.

In November 2013, Johnson & Johnson agreed to pay $2.2 billion to the federal government to settle its Risperdal illegal marketing claims.