Antipsychotics and older people

Frequently asked questions about the use of antipsychotic medicines in older people

Key points about antipsychotics and older people

  • Antipsychotic medicines are sometimes used for the behavioural and psychological symptoms of dementia if non-medication options have not worked.
  • Antipsychotic medicines must be used with caution in older people because they can cause serious harm.
  • They need to be prescribed to the right people for the right reason and for the right period of time.
  • In older people, antipsychotic medicines should be as a trial at the lowest dose likely to provide benefit. 
  • Generally they shouldn't be used for longer than 3 months, unless they're also needed for another health condition.
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Antipsychotics may be considered for people with moderate to severe behavioural and psychological symptoms of dementia (BPSD) if non-medication options haven't worked.

  • They may be used when aggression, agitation or psychotic symptoms are causing severe distress or when people are at risk of harming themselves or others.
  • The effectiveness of antipsychotics can vary between different types of BPSD (eg, psychosis, delusions, hallucinations, agitation or aggression) and between different people.

Antipsychotics are also used for some people with other mental illness.

Older people are particularly at risk of serious side effects from antipsychotic medicines, eg, drowsiness, risk of falls, pneumonia (lung infection), stroke and heart problems.

It's best for antipsychotic medicines to be used at the lowest dose likely to provide benefit and for no longer than 3 months. This is unless the medicine is being prescribed for another long-term mental health condition, or for another specific reason.

  • Antipsychotics are not useful for treating symptoms such as wandering, shouting, touching or social withdrawal, or symptoms related to a specific trigger.
  • Antipsychotics should be avoided if people have Lewy body dementia or Parkinson’s disease with dementia. 
  • Antipsychotic medicines are generally not recommended for anxiety or depression because of the risk of serious side effects. Other options such as psychological therapy and antidepressant medicines should be tried first. 

Risperidoneand quetiapine are currently the most commonly prescribed antipsychotic medicine for BPSD. Treatment should be started as a trial at the lowest dose likely to provide benefit, and treatment should be reviewed regularly. If there has been no sign of improvement after a few weeks, the medicine should be withdrawn.

People who do respond to treatment should notice a difference within 3 months and withdrawal of treatment should be trialled. If an antipsychotic isn't tolerated because of side effects, other antipsychotics may be considered.

Antipsychotics shouldn't be used for older people who are having problems sleeping. Sleep hygiene is the preferred treatment, eg, establishing a bedtime routine, avoiding alcohol and stimulants before bedtime and not staying in bed when not sleeping. Read more about tips for better sleep.

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Credits: Sandra Ponen, Pharmacist, Healthify He Puna Waiora. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Joanna Wang, Old Age Psychiatrist; Angela Lambie, Pharmacist

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