In elderly patients with dementia-related psychosis, what is the effect of antipsychotics on mortality?

• A. Increases mortality
• B. Decreases mortality
• C. No effect
• D. Increases falls

Answer: (A)

Antipsychotics in dementia-related psychosis increase overall mortality. Large trials and meta-analyses have consistently shown a higher risk of death in frail elderly patients with dementia who are treated with these medications compared with those not receiving them. The increased risk stems from multiple factors, including cardiovascular events (such as arrhythmias and stroke), infections (notably pneumonia), and complications from sedation or reduced mobility (like dehydration and falls). Because of this, regulatory agencies place a boxed warning on these drugs for dementia-related psychosis, and clinicians are urged to use the lowest effective dose for the shortest possible duration, only after nonpharmacologic approaches have failed, with close monitoring. The idea that mortality might stay the same or decrease is not supported by the evidence; while falls can contribute to harm, the overall signal is an increased risk of death.