Counting the Unnecessary Deaths

by Anthony Chicotel, CANHR Staff Attorney

While listening to various presentations that decry the misuse of antipsychotic drugs, I often hear a statement to the effect of “studies show that for every 100 elderly dementia care patients treated with antipsychotic drugs, there may be 1 death while only 9 to 25 patients are helped.” The statement is made in reference to the significant dangers of antipsychotics, suggesting that 9 to 25 beneficial uses may not be enough to warrant the risk of 1 untimely death.

But I’ve always heard that statement differently than I believe it’s intended. In cases where caregivers are at their wit’s end trying to manage dementia-related behavior for an elderly person who probably does not have much longer to live, the ratio of 9-25 patients helped to 1 patient dead may actually not sound so bad.

That’s why it is so important to understand the full measure of the studies. As stated in “Death and Atypical Antipsychotic Drug Treatment for Dementia,” (Journal Of the American Medical Association (“JAMA”), Vol. 294, No. 15, p. 1941) the ratio of 9-25 patients helped to 1 patient dead is only for a treatment period of 10-12 weeks. The DART-AD study, (The Lancet Neurology (2009), Vol. 8, pp. 151-157) perhaps the most comprehensive look at antipsychotic use for elderly people with dementia, monitored the impact of antipsychotic use versus a placebo over a three year period and found mortality rates much greater than 1 out of 100. The following chart is illustrative:

Risk of death of Antipsychotics for People with Dementia

Time Point (months) Survival Rate (%) of those Who Continued to Receive Antipsychotic Survival Rate (%) of those Receiving Placebo (%)
12 70 77
24 46 71
36 30 59

By the end of year 1, antipsychotics may have been responsible for 7 additional deaths per 100 patients. By the end of year 2, the number of additional deaths was 25, by the end of year 3, it was 29 per 100 patients.

The cost-benefit analysis of the use of antipsychotics to “treat” dementia looks even worse when we take a closer examination of the studies. The notion that 9 to 25 patients are “helped” by the use of antipsychotics depends entirely on how we think of being helped. If “help” means successfully sedating and subduing the patient so they stop wandering, shouting, or resisting care then yes, there is a fair chance that antipsychotics are helpful. If, however, “help” is supposed to lead to resolving the problem the patient was conveying by wandering, shouting, or resisting care, then antipsychotics are not only not helpful but are actually harmful.

And that is why it makes complete sense that elderly patients with dementia die at an alarmingly increased rate than those given a placebo. Because of their powerfully sedating effects, the use of antipsychotics can often halt the patient’s only means of communicating when something is wrong – through his or her behavior. With the patient unable to express pain, discomfort, or other symptoms of physical problems, they suffer and fail to get needed treatment. In addition, sedation decreases activity levels, exercise, and social engagement, three critical components to vitality. Thus, antipsychotics not only reduce quantity of life, they can destroy quality of life too.

When it comes to analyzing the true costs and true benefits of antipsychotics as a treatment for dementia, patients and their families deserve the complete picture that science provides.

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About achicotel

Anthony Chicotel is a staff attorney for CANHR. His areas of expertise include the rights of long-term care residents, nursing home litigation, health care decision-making, and conservatorships.
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Responses to CANHR blog postings do not reflect the opinions of CANHR or its staff members.

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