Evaluating the Risks of Second Generation Antipsychotic Use in Elders with Dementia- Pharmacy Technician
Dementia develops in 5-8% of adults over the age of 65 years and 25-50% of those over 85 years of age. In addition to a progressive decline in cognition and functioning, patients commonly exhibit behavioral and psychological symptoms of dementia (BPSD). These include physical or verbal aggression, wandering, restlessness, anxiety, depression, sleep disturbance, and psychotic symptoms such as hallucinations and delusions. BPSD contributes substantially to patient distress and caregiver burden, and can result in institutionalization of the patient. Up to 90% of demented patients in nursing homes exhibit BPSD. Strategies to address BPSD include non-drug management, antipsychotics, cholinesterase inhibitors, antidepressants, antiepileptics, and benzodiazepines. Among these options, second generation antipsychotics (SGAs) are widely used, although none have been FDA approved for this indication and there are serious safety concerns linked with their use. This issue summarizes the limited efficacy and tolerability of SGAs when they are used in demented older adults. Detailed explanations of the increased risk for stroke, death, tardive dyskinesia and pneumonia that are associated with SGAs are provided. Ways to minimize adverse effects are discussed along with a comprehensive list of recommendations for non-drug approaches to assist patients with BPSD. Improving quality of care in this vulnerable population requires that healthcare providers be fully cognizant of the risks and benefits of treatment and that patients’ caregivers are making fully informed decisions about using these medications.