Antipsychotic Drugs Put Elderly at Risk for Pneumonia

A new Dutch research study reveals that nursing home patients on <"">antipsychotic drugs are 60 percent more likely to develop pneumonia—in the short term—than those who don’t take the drugs.  According to the researchers, there is greatest risk during the first week after patients start taking the medications.  This risk gradually decreases in time.  “The risk of developing pneumonia is not associated with long-term use, but is the highest shortly after starting the drug,” said study authors Dr. Rob van Marum and Dr. Wilma Knol, who warned that “all antipsychotic drugs may be associated with pneumonia in elderly patients.”

The study, which was published in the current issue of the Journal of the American Geriatrics Society, is the first of its kind to show an association between pneumonia risk and the use of antipsychotic drugs. Antipsychotics are often used in the treatment of psychosis and behavioral problems in elderly patients diagnosed with dementia and delirium.  Nearly 40 percent of nursing home residents may be prescribed antipsychotics, according to the study authors and, in over half such cases, antipsychotics are prescribed for inappropriate reasons.  For instance, the drugs are often used to treat behavioral problems in dementia patients, but evidence shows these drugs have limited effectiveness in these patients and other, recent research indicates that the use of antipsychotic drugs in the elderly is linked with an increased risk of illness and death.

A recent British study concluded that the continuing use of antipsychotic drugs provides neither cognitive nor neuropsychiatric benefits when taken by Alzheimer’s patients.  Research was conducted by King’s College Hospital in London where 165 patients who were already being treated with antipsychotic drugs were studied.  The patients were divided into two groups:  One continued treatment with the drugs; the other group stopped treatment.  The groups were assessed six and 12 months later and researchers found no difference between the two groups in terms of cognitive decline or in the number of neuropsychiatric problems.

Most older dementia patients display some neuropsychiatric symptoms—agitation, aggression and psychosis—and physicians often prescribe antipsychotics to manage or control symptoms; however, there are concerns, including increased risk of stroke, sedation, edema, chest infections, and parkinsonism.  Long-term antipsychotics may also lead to a worsening of cognitive decline.

Earlier this year, other studies found that new antipsychotic drugs for severe mental illness like schizophrenia and bi-polar disorder were being prescribed in increasing numbers to young children and the elderly and that doctors were helping to increase drug sales by prescribing them for other, more common conditions such as dementia and aggression.  Also, drug makers are obtaining new approvals from the FDA to treat more conditions and over 26 percent of the nation’s nursing home residents were on antipsychotics in early 2007, compared with 19.4 percent in 1999, federal surveys show.  Those drugs do little to help dementia patients, said Lon S. Schneider, a California psychiatrist and lead investigator of the CATIE-AD study of outpatients with Alzheimer’s.  He and his colleagues also  found that patients on anti-psychotics for 12 weeks had a slightly greater risk of dying sooner than those on placebo.

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