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Certain Antipsychotics & Kidney Problems in Elderly

'Off-label' use to treat dementia-related behavior may carry significant risks, study finds


One percent of adults taking the antipsychotics were hospitalized for acute kidney injury, compared to 0.6 percent of adults not taking the medications. And 6.8 percent of adults taking the antipsychotics died from any cause, compared to 3.1 percent of adults not taking the drugs.

Garg and Porsteinsson acknowledged that these mental health medications can be appropriate for adults with true psychosis.

"There are certain situations where there is no alternative when people are psychotic, and these drugs can make a major difference in outcomes for those individuals," Porsteinsson said, "but their use has to be balanced, not used simply for sleep impairments or anxiety."

Porsteinsson said behavioral problems in adults with dementia can result from factors such as pain, hunger, undiagnosed medical conditions or environmental triggers. These should be investigated first, he said.

"Is their room too hot or too cold? Do they truly dislike their roommate in a shared room? Do they have some unmet need?" Porsteinsson suggested. "They cannot communicate their needs so there's a lot of thoughtful detective work that needs to go into this."

If a regularly visiting family member misses a week, for example, the older adult may feel distressed or abandoned or worried, he said. In such situations, the first treatment should be trying to address those needs or trying to distract or redirect the older adult.

"Get them involved in some sort of activity that basically channels their restlessness or their unbridled energy into something a little more constructive," Porsteinsson said. "If that doesn't work, then you think medications."


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