Table 4.

Take-home messages on the implications of adverse outcomes associated with antipsychotics in older patients with dementia

The use of antipsychotics in older adults with dementia can reduce agitation, psychosis, and associated distress; however, no medication is considered safe in this population

Antipsychotics are generally associated with an increased risk of mortality and cerebrovascular events

Due to slightly higher risk of mortality and cardiovascular and extrapyramidal side effects compared to second-generation antipsychotics, first-generation antipsychotics should be reserved for emergencies

Antipsychotic-related mortality may be higher at the beginning of treatment, hence a thorough risk-benefit assessment including cardiovascular risk should be conducted before commencing these medications

The risk does, however, remain increased throughout the treatment (evidence for up to 6 years [39]); the need for continuation of antipsychotics should be regularly reviewed and medication ceased as soon as possible. Withdrawing antipsychotic therapy may improve long-term survival and is not associated with relapse of agitation and psychosis

Antipsychotic treatment is associated with higher rates of hospitalisations and dependency on long-term care, including care home admissions

Use of antipsychotics may not be cost-efficient for healthcare systems

Treatment with antipsychotics requires physical health monitoring. In the absence of dementia-specific monitoring requirements, older adults with dementia should follow the same recommendations as the general patient population

Despite the clear risks of using antipsychotics in dementia patients, their risk-benefit balance makes them preferable to other psychotropic medications