Antipsychotic Drugs and Seniors
There is growing problem with inappropriate and excessive drug prescription
to people over the age of 65. Physicians routinely prescribe antipsychotic drugs
to their aging patients; the benefits are doubtful and the negative effects are
well established. In a review of physicians attitudes and prescribing practices,
Damestoy et al stated:"The inappropriate use of medications by elderly patients
has become a public health concern because of its prevalence and its potential
impact on patient autonomy physicians were unanimous in their view of the aging
process as a very negative experience.
In April 2010, the drug company AstraZeneca agreed to pay $520 million to
settle US government allegations that it illegally promoted the antipsychotic
drug Seroquel (quetiapine fumarate) as a treatment for medical conditions for
which it had not received approval such as Alzheimer's disease, depression and
sleeplessness. AstraZeneca's total sales of Seroquel reached $4.87 billion in
2009.
Fick et al stated: "A literature search will uncover articles that describe
the toxic effects of medications and drug-related problems for older adults. It
has been conclusively demonstrated that the toxic effects of medications and
drug-related problems can have profound medical and safety consequences for
older adults, with enormous economic consequences on the healthcare system. If
medication-related problems were ranked as a disease by cause of death, it would
be the fifth leading cause of death in the United States. Therefore, the
prevention and recognition of drug-related problems in elderly patients is one
of the principal healthcare quality and safety issues for this decade. An
extensive survey of the literature was conducted of all relevant medications
used in elderly patients. This study identified 48 individual medications or
classes of medications to avoid in older adults and their potential concerns and
20 diseases/conditions and medications to be avoided in older adults with these
conditions. Of these potentially inappropriate drugs, 66 were considered by the
panel to have adverse outcomes of high severity. "
Some of the drugs prescribed are tranquillizers and sleeping pills that add
to memory loss and confusion, effects that are easily ignored in the elderly.
Antipsychotic drugs are potent and harm elderly patients. These drugs will not
correct aberrant behavior, improve cognition or memory but disable and further
damage an already compromised brain. Patient demand has always driven the
prescription drug industry to produce more chemicals and to encourage physicians
to prescribe these chemicals. A well trained physician will understand that
psychotropic drugs are mostly useful for brief interventions and that long-term
use is usually not desirable. Patients become dependent on psychotropic drugs
and many demand renewed prescriptions over many years. Damestoy stated: "Many of
the (elderly) patients had been using psychotropic medication for a long time,
some for as long as 20 years. Patients with a strong attachment to anxiolytic
drugs become demanding and difficult when their use of psychotropic drugs was
questioned."
The path of least resistance for physicians is to enquire little and renew
prescriptions automatically. In a study of 224 patients with a diagnosis of
probable Alzheimer's disease, that risk of deterioration was significantly
higher among patients who were taking antipsychotics or sedatives compared with
those who were not on any drugs. Patients who were taking both antipsychotics
and sedatives had the highest risk of rapid deterioration.
Antipsychotic drugs were developed to treat schizophrenia, a disease of young
people. The atypical antipsychotics - clozapine, olanzapine, quetiapine and
risperidone have all been used to treat elderly patients, especially those with
dementia. There is no evidence that any of these drugs will alleviate dementia
in any way. They are used as "chemical straight jackets to immobilize nursing
home residents. Among the problems created by these drugs are Parkinsons
disease, weight gain, hyperglycemia and diabetes 2. Janssen-Ortho, the company
that markets Risperdal (risperidone), issued drug safety information bulletin
linking the drug to increased risk of strokes in elderly patients. Since there
is significant doubt that this drug should be used in any elderly patients, the
increased risk of diabetes and stroke is a definitive contraindication. The
strength of the association between antipsychotics and diabetes varies. A number
of reports implicate chlorpromazine, clozapine, and olanzapine. An Ontario study
involving 20,000 patients in nursing homes revealed that 25% of the residents
are prescribed antipsychotic medications within the first year of admission. I
suggest a more appropriate level of use would be less than 1% of residents.
The Institute for Clinical Evaluative Sciences, in Toronto, Ontario, Canada
carried out a surveillance study of antipsychotic drug use in adults with
dementia 66 years of age or older.. The records of 20,682 adults living in the
community and 20,559 adults living in a nursing home were examined. The most
commonly prescribed atypical antipsychotics were risperidone, olanzapine, and
quetiapine, and the most common conventional antipsychotics were haloperidol,
loxapine, and thioridazine hydrochloride. They found that patients given
antipsychotic drugs were up to 4 times more likely to be hospitalized or die
within 30 days. They warned that serious side effects occur shortly after
starting the drug.
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