Good morning, ProviderNation. Antipsychotics may not actually be as deadly as previously thought , a bold, new study finds. Dutch researchers looked back over nearly a half century of research on antipsychotics and analyzed them for subtle bias that may have skewed results. Their findings, published in the latest issue of JAMDA, are no less than a frontal assault on conventional wisdom.
“The results … refute the observation association between conventional antipsychotics in general… They do not confirm an increased mortality risk for conventional antipsychotics in elderly patients with dementia, either,” University of Groningen Prof. Tessa A. Hulshof writes for the team. “Hence, our findings question the scientific support for the warning against conventional antipsychotics in patients with dementia that was based on the observational findings.”
Since 2008—when the FDA and the UK Commission for Drug Safety issued warnings about the potentially lethal consequences of antipsychotics—providers have been trying to find other ways of helping frail elders deal with aggression and other manifestations of late-stage dementia.
The Apple Cart, Upset
The problem, Hulshof and Co. write, is that the science behind these mammoth efforts “seemed poor.”
“Many cohort studies have reported an association between conventional antipsychotics and an increased risk of mortality when compared with atypical antipsychotics or no use in elderly patients. However, none of the studies adjusted for severity of illness. Therefore, terminal illness and comorbid delirium may have consistently confounded the observation findings,” Hulshof says.
These are not just details, the team says.
“The prevalence of cerebrovascular disease, heart failure, dementia, and depression was generally high. Many cohort studies excluded patients with schizophrenia,” Hulshof writes. “Trials, on the other hand, excluded patients who are terminally ill. They included patients treated for symptoms of dementia or for prevention of delirium after noncardiac surgery. These patient groups can be considered frail because of their age, cognitive impairment, somatic morbidity, and functional disability.”
George Orwell once famously ran a thought experiment in which he tasked himself with arguing with someone who was convinced that the earth was flat. His findings were slightly depressing ( it’s Orwell, after all): that, despite homo sapiens’ post-Enlightenment hymns to reason and evidence, most of what we moderns “know” rests, ultimately, on an appeal to authority.
Such exercises, as Orwell knew, are good for their own sake. So, whether Hulshof et al. are ultimately “right,” it’s always work taking a moment to go back through the storage room of one’s mental attic.
What’s also interesting is that, even if continuing studies bear Hulshof out, it probably won’t change providers’ commitments to curbing antipsychotics in care centers.
Mendelsohn’s Newest Suite
Meanwhile, the fine folks at Levin & Associates are reporting that National Health Investors has made it official and changed interim CEO Eric Mendelsohn’s title to “CEO Eric Mendelsohn,” effective Oct. 5.
Mendelsohn previously was senior vice president for corporate development at Emeritus, where “he led the way in such large transactions as the $3 billion joint venture with Blackstone and the $278 million Summerville merger,” Levin’s inestimable Ben Swett says.