Psychotropic Medications, the Elderly, and Dementia

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Psychotropic Medications, the Elderly, and Dementia

By CareerSmart® Learning Contributor, Sept 9, 2017, as published by Healthcare Hot Spot

“Psychotropic medications” is an umbrella term for any medication that alters a person’s mental state.  Several types of medications fall under this umbrella, including antipsychotics, antidepressants, mood stabilizers, and anxiolytics.  Even though these medications are commonly prescribed, they often pose serious, if not fatal, consequences for older adults and those with dementia.  Psychotropic medications have serious side effects and require close monitoring:

1. Severe side effects:  Not only are older adults more sensitive to psychotropic medication than their younger counterparts, they are also more vulnerable to the side effects.  Anxiolytics can cause side effects of “sedation and memory and psychomotor impairment” (Lindsey, 2009).  Older adults can experience heighted side effects possibly due to decreased drug clearance.  For people with dementia, the U.S. Food and Drug Administration warns that antipsychotics increase the risk for cardiovascular events and mortality (Gavin, 2015).  The concerning issue remains the high percentage of older adults with dementia who are prescribed antipsychotics given the increased risks.  In one study, a third of older adults with dementia in nursing homes were prescribed antipsychotics and approximately 14% of older adults with dementia in the community were prescribed antipsychotics (Gavin, 2015).  The increased risk of mortality ranged from about 2% for Seroquel to about 12% for haloperidol, depending on the psychotropic medication (Mausta, Kim, & Seyfried, 2015).
2. Vigilant monitoring:  This translates to healthcare staff having a good understanding of the medications and their associated side effects, for example, older adults taking benzodiazepines should be monitored for cognitive and functional declines (Lindsey, 2009).  It’s also important to understand which medications are not recommended, such as tricyclic antidepressants are not the first choice compared to selective serotonin reuptake inhibitors because they increase older adults’ fall risk (Lindsey, 2009). 

Psychotropic medications have varied side effects and older adults typically have co-morbidities that need to be taken into consideration; combining the two requires careful monitoring.  If working with older adults and people with dementia, healthcare professionals need to understand the risks and side effects of psychotropic medications that are specific to those populations because the consequences could be fatal. Routine medication reviews to determine dosage reduction or discontinuation of psychotropic drugs should be part of the care plan and the reasons for continuation of such medication should be thoroughly documented. More importantly, ruling out any underlying causes for the behavioral problems and nonpharmacological management should always be the first intervention of choice.   

You may also be interested in:

Lindsey, P.L. (2009). Psychotropic medication use among older adults: What all nurses need to know. Journal of Geriatric Nursing; 35(9): 28-38. doi:  10.3928/00989134-20090731-01

Gavin, K. (2015). Are antipsychotic drugs more dangerous to dementia patients than we think? University of Michigan, Michigan Medicine.  Retrieved from http://www.uofmhealth.org/news/archive/201503/are-antipsychotic-drugs-more-dangerous-dementia-patients-we

Maust, D.T., Kim, H.M., Seyfried, L.S., et al. (2015). Antipsychotics, other psychotropics, and the risk of death in patients with dementia.  Journal of the American Medical Assosciation; 72(5): 438-445. doi:10.1001/jamapsychiatry.2014.3018