Elderly as much at risk with old mental health drugs as new ones

Dec 2 2005

Researchers at the Brigham and Women's Hospital in Boston are saying that many of the older drugs designed to treat mental problems such as delirium, agitation and psychosis may be even more hazardous to the elderly than newer medicines that now carry U.S. government warnings.

The Food and Drug Administration warned in April that newer "atypical" anti-psychotic medicines such as Zyprexa and Risperdal nearly doubled the risk of death in elderly people with dementia.

The new study says the very same warnings should have been extended to older drugs such Haldol and Thorazine, available in generic form, because they posed a risk of death that was 37 percent higher than the atypical drugs.

The report also illustrates the risks of taking studies involving mostly younger people and trying to apply those findings directly to the elderly who may react differently to drugs.

It is far more likely that elderly people will be prescribed antipsychotic drugs than people in other age groups.

They are for example prescribed for more than 1 in 4 nursing home patients covered by Medicare.

Nevertheless according to Philip Wang, the chief author of the study, data is scant on how they work in people 65 and older.

He says though it is not known what the benefits are, or what the optimal treatment for them is, the risks are starting to emerge.

He and his colleagues found that among the people taking the newer drugs, 14.6 percent were dead within the first 180 days, while the rate was 17.9 percent for those who began taking the older antipsychotics between 1994 and 2003.

The greatest danger appeared to be when the patients were first taking the medicine and also among people receiving the highest doses.

Wang says the results suggest that clinicians should not simply take the atypical agents they stopped prescribing in response to the FDA warning and replace them with the older drugs, as this is not an inconsequential risk, as the elevation in the death rate was seen over a very short period of time.

In the study Wang's team used a database of 22,890 seniors who had drug insurance benefits in Pennsylvania.

The report is published in the New England Journal of Medicine.