Antipsychotic medications for older adults with delirium admitted to hospital

Antipsychotic medications are commonly used in hospitals to manage patients with delirium, which affects a significant percentage of older adults admitted to the hospital. However, these medications should not be used as standard treatment for delirium. Instead, delirium management should focus on a...

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Veröffentlicht in:Canadian Medical Association journal (CMAJ) Jg. 195; H. 31; S. E1038 - E1039
Hauptverfasser: Reppas-Rindlisbacher, Christina, Stall, Nathan M., Wiesenfeld, Lesley
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Canada Elsevier Inc 14.08.2023
CMA Impact Inc
CMA Impact, Inc
Schlagworte:
Aged patients
Antipsychotic drugs
Antipsychotics
Complications and side effects
Delirium
Dosage and administration
Drug dosages
Drug therapy
Hospital patients
Hospitalization
Hospitals
Internal Medicine
Older people
Patients
Practice
Psychiatry
Psychotropic drugs
Systematic review
Canada
ISSN:0820-3946, 1488-2329, 1488-2329
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Zusammenfassung:Antipsychotic medications are commonly used in hospitals to manage patients with delirium, which affects a significant percentage of older adults admitted to the hospital. However, these medications should not be used as standard treatment for delirium. Instead, delirium management should focus on addressing underlying causes, optimizing environmental factors, and implementing nonpharmacologic interventions. A systematic review found no difference between antipsychotic medications and placebo in terms of delirium duration, severity, length of hospital stay, or mortality. However, most studies did not differentiate between hypoactive and hyperactive delirium or examine the impact of antipsychotic medications on patient and family experience. Antipsychotic medications may be considered for patients with delirium experiencing severe agitation or distress, or for those at risk of self-harm, harming others, or compromising essential medical therapy. They are preferred over benzodiazepines, except for specific indications such as delirium associated with alcohol or benzodiazepine withdrawal. However, they should not be used for hypoactive delirium. Before using antipsychotic medications, it is important to assess the individual risks and benefits, as these medications can have serious adverse effects such as sedation, hypotension, falls, parkinsonism, QT interval prolongation, and aspiration pneumonia. Frequent reassessment of treatment is necessary to determine if dose reduction or discontinuation is appropriate. Many patients are discharged from the hospital on antipsychotic medications without a clear indication for ongoing treatment. Therefore, these medications should be prescribed at the lowest effective dose for the shortest possible duration and patients should be re-evaluated shortly after discharge.
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ISSN:0820-3946
1488-2329
1488-2329
DOI:10.1503/cmaj.230227