Walid Gellad, MD

Treatment of dementia showed a similar pattern of high demand and inappropriate use of medications. According to the authors of a recent study published in Medical Care, “veterans with dementia but no documented psychosis were as likely as those with an evidence-based indication to receive an antipsychotic.”

The authors of the dementia treatment analysis used the same set of records as the researchers in the American Geriatric Society study and found that 26% were prescribed an antipsychotic, although fewer than 60% had an evidence-based indication for use. Antipsychotic prescriptions were most common among residents with aggressive behavior, who were three times more likely to be prescribed the medications than non-aggressive patients. Residents in Alzheimer or dementia care units were 66% more likely to receive antipsychotics.3

Lead researcher Walid Gellad, MD, staff physician and researcher at the Pittsburgh VA Medical Center and VA Center for Health Equity Research and Promotion (CHERP), told U.S. Medicine “there is a long history of prescribing antipsychotics in dementia patients. In some cases, the behavioral problems can be very troublesome to the patient or to the family, and physicians and other clinicians want to do something to try and help, but there are limited options.”

Patients with dementia exhibit a wide range of symptoms and behaviors that clinicians or families might want to address, said Gellad, who also is an assistant professor of medicine and health policy at the University of Pittsburgh.

“Dementia patients in nursing homes get symptoms like depression, apathy, agitation, aggression, psychosis, hallucinations, delusions, sleep problems and also have behaviors like wandering,” he said.

In some cases, use of antipsychotics may be appropriate, even if an official diagnosis of psychosis was missing.

“In our analysis, we classified those patients with psychotic symptoms in dementia (like hallucinations) actually as potentially appropriate, based on Centers for Medicare and Medicaid Services’ guidance to long-term care facilities,” said Gellad. But, he noted, “whether an antipsychotic is truly ‘inappropriate’ or not really depends on the clinical situation, which we measured as best as we could with the data we had. There’s not one behavior or another for which antipsychotics might be prescribed inappropriately — they could be inappropriate in any behavior.”