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Risks may outweigh benefits of elderly antipsychotic use
NEW Australian research may have tipped the scales against prescribing antipsychotics for the elderly, with researchers saying the risks may have overtaken the benefits.
As concern continues to mount over rising atypical antipsychotic use in Australia, an analysis has found substantial increases in hip fractures and pneumonia in the first 12 weeks of treatment in over-65s.
For every 2-4 people who benefited from atypical antipsychotics, one would be hospitalised with pneumonia, said lead author Nicole Pratt, senior research fellow at the University of South Australia’s Sansom Institute. And for every 5-13 patients who benefited, one would be hospitalised for hip fracture.
“Considering the modest improvement in terms of efficacy and the increased risk of mortality associated with hip fractures and pneumonia, the risk associated with antipsychotics may now outweigh the benefit,” said Ms Pratt, who presented the findings at the recent National Medicines Symposium in Melbourne.
The study included data from 13,932 veterans hospitalised for pneumonia and 8284 hospitalised for hip fracture.
Professor Henry Brodaty, director of aged care psychiatry at Prince of Wales Hospital, said antipsychotics should be avoided in the elderly unless there were clear indications and other strategies had been unsuccessful.
“And [even] then the dose should be as little and for as short as possible, and informed consent should be obtained from the patient or a proxy if the patient is incompetent,” he said.
Ms Pratt said there had been some success in tackling the problem, with risperidone usage among veterans dropping by 15% as a result of their ongoing evaluation of the Veterans’ Medicines Advice and Therapeutics Education Services program.
Mechanisms for the link to pneumonia were unclear, she said, but research had suggested that antipsychotics may impair swallowing, leading to aspiration pneumonia.
A recent study found the rate of atypical antipsychotics prescribing in Australia has risen considerably in recent years.
While 61% of antipsychotics prescribed in 2002 were atypical, by 2007 the proportion had risen to 77 per cent.