Delirium (sudden confusion or a rapid change in mental state) remains a serious challenge for our health care system. Delirium affects 15 to 26 percent of hospitalized older adults and can be particularly problematic because those experiencing the condition may interfere with medical care or directly harm themselves or others. Besides behavioral therapy and physical restraints, antipsychotic medicines are among the few therapeutic options healthcare providers can use to ease delirium and protect patients and caregivers--but antipsychotics also come with risks of their own.
To learn more about the effect of antipsychotic medicines on older hospitalized patients, a research team created a study published in the Journal of the American Geriatrics Society. This study included information from hospitalized patients at a large academic medical center in Boston.
The researchers looked specifically at death or non-fatal cardiopulmonary arrest (heart attack) during hospitalization.
The researchers learned that adults taking "first-generation" or "typical" antipsychotic medications (medicines first developed around the 1950s) were significantly more likely to experience death or cardiopulmonary arrest, compared to people who did not take those drugs. Taking "atypical" or "second-generation" antipsychotics (so named because they were developed later) raised the risk for death or cardiopulmonary arrest only for people aged 65 or older.
In the past, other studies have suggested that typical antipsychotic medications could cause sudden death, and that atypical antipsychotics could raise peoples' risks for falls, pneumonia and death. What's more, another large study also suggested that both types of antipsychotic medicines posed a risk for fatal heart attacks.
Despite these known risks, atypical antipsychotics are often prescribed for people in the hospital. One recent study of patients at Beth Israel Deaconess Medical Center in Boston found that antipsychotics were prescribed for nine percent of all adults who were hospitalized for non-psychiatric causes. Another large recent study found that using antipsychotics to prevent or treat delirium did not lower the risk for death, did not lessen the severity of delirium or shorten its duration, and did not shorten the time people spent in the intensive care unit (ICU) or their hospital length of stay.
"Delirium is common in older hospitalized patients and difficult to treat, but antipsychotic medications should be used with caution regardless of age," said the authors.
This summary is from "Antipsychotics and the Risk of Mortality or Cardiopulmonary Arrest in Hospitalized Adults.)" It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Matthew Basciotta, MD; Wenxiao Zhou, MS; Long Ngo, PhD; Michael Donnino, MD; Edward R. Marcantonio, MD, MSc; and Shoshana J. Herzig, MD, MPH.
About the Health in Aging Foundation
This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.
About the Journal of the American Geriatrics Society
Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.
About the American Geriatrics Society
Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has--for 75 years--worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.