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Long-term antipsychotic use common among older adults, despite concerns

Long-term use of antipsychotics is common among older adults in the United States despite safety concerns, according to study results published in Journal of Clinical Psychiatry.

“Antipsychotics are one of the most commonly prescribed classes of medications in the United States. In adults, they have been approved by the U.S. Food and Drug Administration as a primary treatment for schizophrenia, bipolar disorder, and Tourette’s disorder (haloperidol and pimozide) as well as an adjunctive treatment for major depressive disorder (aripiprazole and olanzapine),” Mark Olfson, MD, MPH, of Columbia University and New York State Psychiatric Institute, and colleagues wrote. “Yet in office-based practice only about half (45%) of antipsychotic prescriptions to adults 18 to 64 years of age and approximately one-quarter (26%) of such prescriptions to adults aged 65 years and older are to patients who have been diagnosed with one of these FDA-approved indications.”

Mark Olfson

To determine patterns of antipsychotic treatment among older and younger adults in the United States, researchers analyzed the IMS LifeLink LRx Longitudinal Prescription database for adults who filled antipsychotic prescriptions in 2006 and 2008 to 2010.

“The FDA has issued warnings of increased mortality regarding antipsychotics in elderly patients with dementia, particularly for ‘atypical’ antipsychotics” Michael Schoenbaum, PhD, of the NIMH, said in a press release. “Nevertheless, around 80% of antipsychotic prescriptions among adults 65 and older were for atypical medications.”

Overall, adults aged 20 to 34 years accounted for 0.93% of antipsychotic use in 2010, adults aged 35 to 59 years accounted for 1.46%, adults aged 60 to 64 years accounted for 1.54%, adults aged 65 to 69 years accounted for 1.36%, adults aged 70 to 74 years accounted for 1.36%, and adults aged 80 to 84 years accounted for 2.09%.

Women were more likely to use antipsychotics than men.

The percentage of older adults with long-term antipsychotic use were 53.7% for ages 70 to 74 years, 49.2% for ages 75 to 79 years and 46.2% for ages 80 to 84 years.

The percentage of adults with antipsychotic prescriptions from psychiatrists decreased as age increased, from 66.2% at age 20 to 34 years to 20.6% at age 80 to 84 years.

“Typically, psychiatrists are more familiar with the properties of antipsychotic medications. However, about half of the people age 65 to 69 and only one-fifth of those age 80 to 84 who were treated with antipsychotics received any of these prescriptions from psychiatrists,” Schoenbaum said in the release.

Among older adults taking antipsychotics with any mental disorder or dementia diagnosis, 37.2% of those aged 75 to 79 years and 47.8% of those aged 80 to 84 years were diagnosed with dementia.

“The results of the study suggest a need to focus on new ways to treat the underlying causes of agitation and confusion in the elderly,” Olfson said in the release. “The public health community needs to give greater attention to targeted environmental and behavioral treatments rather than medications.” – by Amanda Oldt

Disclosure: Olfson reports no relevant financial disclosures. Please see the full study for a list of all researchers’ relevant financial disclosures.