Antipsychotics Linked to Heart Failure, Stroke, Other Health Risks in Dementia Patients: Study

Findings come amid continuing concerns about the overuse of antipsychotics for dementia patients in long-term care facilities, which is considered a form of "chemical restraint" or nursing home abuse.

A new study warns that prescribing dementia patients antipsychotic drugs, which have controversially been used as a form of chemical restraint to manage difficult residents in nursing homes, may also increase the risk of several serious health conditions, with the highest risks occurring almost immediately after treatment begins.

Researchers from the U.K. report that patients with dementia given drugs like Abilify and Zyprexa faced an increased risk of suffering kidney injury, blood clots, stroke, bone fractures, heart attack, heart failure, and pneumonia, according to the findings published April 17 in the journal The BMJ.

Dementia involves a group of conditions marked by memory loss, difficulty thinking and making decisions. The impairment often causes other disruptions to everyday activities, like eating and bathing. Alzheimer’s disease is the most common type of dementia and most often affects older people.

Antipsychotics Often Used as “Chemical Restraints”

Antipsychotics are approved for treatment of medical conditions like schizophrenia and psychotic symptoms, such as hallucinations, delusions, and disordered thinking. However, they have also often been prescribed to dementia patients that do not actually need the treatment, as a means of calming and sedating them.

The controversial practice is known as “chemical restraint” for dementia patients, and it is widely considered a form of nursing home abuse in long-term care facilities. The unnecessary prescriptions increased dramatically during the COVID-19 pandemic, and rates still have not returned to prior levels.

In recent years, federal regulators and health experts have warned against prescribing antipsychotics to dementia patients when there is not a clear medical purpose, as it has been known to cause a number of side effects, including dizziness, drowsiness, confusion, and shaking, making it easier for older patients to fall and suffer other serious injuries, including death.

To address the problem, the U.S. Centers for Medicare & Medicaid Services (CMS) launched investigation into unnecessary use of antipsychotics on nursing home residents early last year. The investigation will include nursing home audits to ensure the facilities are following proper prescribing guidelines.

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In this latest study, researchers looked at data on nearly 174,000 adults diagnosed with dementia from 1998 to 2018. They compared patients prescribed antipsychotic drugs with subjects who were not given the drugs.

The most commonly prescribed antipsychotics include Abilify, Zyprexa, Risperdal, Seroquel, and Haldol. These antipsychotics accounted for 80% of all prescriptions in the study, researchers noted.

While some of the risks of giving dementia patients antipsychotics were already known, the researchers indicated they found a far wider range of health risks than anticipated.

According to the findings, dementia patients receiving antipsychotics increased the risk of kidney injury by 72%, blood clots by 62%, stroke by 61%, bone fractures by 43%, heart attack by 28%, and heart failure by 27%.

Current use of antipsychotics among patients with dementia doubled their risk of developing pneumonia, which can become fatal for older patients. Roughly 4.5% of dementia patients using antipsychotics developed pneumonia within three months of starting the medication, compared to 1.5% of patients not taking antipsychotics.

Researchers determined the risks were greatest during the first week of taking the medication, especially the risk of pneumonia. They recommended doctors stop prescribing antipsychotics to dementia patients or reduce prescriptions to help prevent serious side effects.

“Antipsychotic use compared with non-use in adults with dementia was associated with increased risks of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, but not ventricular arrhythmia,” the researchers concluded. “The range of adverse outcomes was wider than previously highlighted in regulatory alerts, with the highest risks soon after initiation of treatment.”

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