Antipsychotic drugs up pneumonia risk in elderly

Older patients given antipsychotic drugs are at increased risk of pneumonia, particularly during the first week after starting treatment, Dutch researchers report. Thirty days after treatment begins, however, the risk is no longer apparent.

Elderly people are often prescribed antipsychotic drugs, Dr. Rob J. van Marum, at University Medical Center in Utrecht, and colleagues point out in a report in the Journal of the American Geriatrics Society. Usually treatment is related to controlling the effects of dementia, but not always.

In fact, studies have shown that up to 40 percent of nursing home residents are treated with the drugs, and in half of those cases the treatment is “inappropriate.”

To look at the risk of pneumonia with antipsychotic drugs, the researchers studied information from community pharmacies and the hospital records of 22,944 patients aged 65 or older who received a prescription for an antipsychotic at some point between 1985 and 2003.

After taking into account factors such as age, other medications, and other illnesses, the investigators found that the likelihood of being hospitalized for pneumonia was 60 percent higher for subjects who were currently on an antipsychotic medication than for those who were weren’t.

The risk was nearly five-times higher during the first week of antipsychotic treatment, but fell sharply over the next month, the team reports.

They say these findings are consistent with a recent report of increased mortality among elderly people shortly after starting antipsychotic therapy.

The reason for the increased pneumonia risk is unknown, but van Marum and colleagues suggest that it could be due to difficulties swallowing caused by the drugs, which leads to problems with aspiration and then to pneumonia.

They conclude: “At this time, a careful weighing of the possible risks against the benefits is recommended before starting antipsychotic treatment in elderly people.”

SOURCE: Journal of the American Geriatrics Society, April 2008.