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'Antipsychotics have been used to help manage behavioral and psychological symptoms of dementia (BPSD).' +
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' While the use of antipsychotics have been effective in managing BPSD, there have also been serious concerns regarding antipsychotic use in individuals with dementia.' +
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' For example, there is increased mortality risk associated with use of antipsychotics in people with dementia, resulting in the FDA placing a black-box warning on atypical antipsychotics in 2005 and on conventional antipsychotics in 2010.' +
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' Current literature has expanded on these concerns and have demonstrated increased mortality and increased morbidity with antipsychotic use in older adults.' +
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' The terms "elderly" and "older adults" have historically been defined as individuals aged 65 years and older. Current literature still uses this definition when evaluating antipsychotic use in older adults with dementia.' +
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' However, on the other hand, there have also been literature that has challenged the data supporting the association of antipsychotics with morbidity and mortality.' +
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'There is growing public concern about psychotropic use in older adults. Previous studies have identified higher rates of mortality when patients with dementia are treated with antipsychotic agents, but more recent studies of older adults have demonstrated that this increased risk is seen in all users of antipsychotics, not just those with dementia.' +
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' Multiple studies have shown that this increased risk in mortality is dose-related, and many have demonstrated that the risk is highest within the 30 days of antipsychotic exposure.' +
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' The presence of drug interactions, particularly with cardiovascular agents, antibiotics, other psychotropics, sulfonylureas, theophylline, warfarin, and nonsteroidal anti-inflammatory drugs are also likely contributing to this increased risk.' +
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'Concerns of morbidity related to antipsychotic use in older adults are also increasing. Antipsychotic use has been shown to increase risk of deep vein thrombosis, pulmonary embolism, stroke, and hip fracture' +
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'; and the risk of hip fracture may even be higher in older adults without dementia.' +
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' Antipsychotic use has been shown to be associated with long-term care dependence and nursing home admissions.' +
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" Additionally, there is the possibility that randomized controlled trials have been overestimating efficacy of antipsychotics while underestimating risk of extrapyramidal symptoms due to the trials' imbalances in baseline characteristics." +
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' This notion is further highlighted by a recent network meta-analysis that suggests that atypical antipsychotics offer only a modest benefit over placebo, but is associated with significant safety risks.' +
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'There are newer studies that challenge previous data supporting the association of antipsychotics with morbidity and mortality. In a study of combined data from Sweden and Finland, antipsychotic use was not associated with elevated mortality risk.' +
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' Frailty is one confounding variable that is cited repeatedly in studies evaluating this risk with antipsychotics.' +
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' In a sample of older adults with dementia from an Italian dataset, antipsychotic drugs were not associated with prolonged QT interval.' +
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' In a cohort study of dementia patients who had experienced falls, psychotropics and antipsychotics were not shown to be a predictor of falls leading to hospitalization.' +
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' Moreover, Haque et al actually demonstrated that a reduction in antipsychotic use was associated with increased risk of falls and reported pain.' +
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' Although the increased rates of falls and reported pain were not statistically significant from baseline to intervention, this finding provides an important perspective to consider regarding the unexpected consequences of increased scrutiny and regulation of antipsychotics. Nevertheless, these aforementioned studies conflict with existing literature demonstrating psychotropics increasing risk of falls, hospitalizations, and death in all older adults.' +
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' Other studies have shown that duration of antipsychotic use longer than six months is associated with lower mortality risk.' +
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' These conflicts demonstrate the need for further evaluation of the use of psychotropic medications in older adults and their associated consequences.' +
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'Although recent literature has challenged the association of antipsychotics with morbidity and mortality, there is still a large body of literature that demonstrates morbidity and mortality risk with antipsychotic use in older adults. As such, this measure is appropriate to monitor and improve the quality of care in older adults with dementia.
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