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Antipsychotic Treatment of Adults in the United States

J Clin Psychiatry 2015;76(10):1346–1353

Objective: Despite safety risks associated with antipsychotic medications, little is known about their use in older adults. This article describes patterns of antipsychotic treatment of older and younger adults in the United States.

Method: The IMS LifeLink LRx Longitudinal Prescription database was analyzed retrospectively, focusing on adults who filled antipsychotic prescriptions. The database was searched for the years 2006 and 2008–2010. Denominators were adjusted to generalize annual antipsychotic use percentages by sex and single year of age to the US population. Among adults with any antipsychotic use, percentages with short-term (≤ 30 days) and long-term (≥ 120 days) use, prescriptions from psychiatrists, use of other psychotropic medication classes, and ICD-9 clinical diagnoses were also evaluated.

Results: The percentages of US adults by age group who used antipsychotics in 2010 were 0.93% (20–34 years), 1.46% (35–59 years), 1.54% (60–64 years), 1.36% (65–69 years), 1.36% (70–74 years), 1.58% (75–79 years), and 2.09% (80–84 years). Women were consistently more likely than men to use antipsychotics. The percentages of antipsychotic-treated older adults with long-term use were 53.7% (70–74 years), 49.2% (75–79 years), and 46.2% (80–84 years). Among adults with any antipsychotic use, percentages with prescriptions from psychiatrists decreased with age from 66.2% (20–34 years) to 20.6% (80–84 years). Dementia was commonly diagnosed among antipsychotic-treated adults aged 75–79 years (37.2%) and 80–84 years (47.8%) who had any mental disorder or dementia diagnoses.

Conclusions: Despite concerns over the safety of antipsychotic treatment of older adults, long-term use is common. Key challenges for clinical research and practice include development and implementation of management strategies for older adults that are safer than antipsychotic medications.