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What are the harms versus benefits for antipsychotics in the prevention of delirium?

NOMINATED TOPIC | October 28, 2016
Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What are the harms versus benefits for antipsychotics in the prevention of delirium? What are the harms versus benefits for these drugs compared to the current alternative of non-drug approaches?

  • What are the harms versus benefits for antipsychotics in the treatment of delirium (resolution of delirium, delirium free days, mortality, function, complications from treatment)? Do the harm versus benefits differ in some subgroups of older adults with delirium (such as persons with dementia, critically ill or ICU patients, long-term care)?
Describe why this topic is important.

Delirium is a common, complex and costly condition in older adults, costing the healthcare system $164 billion per year (Leslie, et al., 2011). Delirium occurs most commonly in persons with dementia where antipsychotics have evidence of increased harm (Fick & Inouye, 2005). The number of trials and the use of antipsychotics has been increasing in the past decade for both prevention and treatment of delirium--despite conflicting evidence in this area. In the past several years there have been a few trials of alternatives to antipsychotics for delirium such as melatonin, melatonin receptor agonists such as ramelteon and in surgical patients dexmedetomidine. The use of antipsychotics in some studies have been shown to cause or worsen confusion and lead to other adverse events such as falls and increased mortality. This is a controversial area addressed in the 2015 AGS Beers Criteria. It is crucial to have a strong review to determine the benefits and harms for both prevention and treatment.

How will an answer to your research question be used or help inform decisions for you or your group?

It will help the AGS Beers Criteria panel shape its recommendation and evidence strength for both of these criterion in the 2018 AGS Beers Criteria. This is a controversial area addressed in the 2015 AGS Beers Criteria. This will help guide practice to improve the lives of older adults with dementia and delirium. It is crucial to have a strong review to determine the benefits and harms for both prevention and treatment.

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The American Geriatrics Society (AGS) is a not-for-profit organization of nearly 6,000 health professionals devoted to improving the health, independence and quality of life of all older people.
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American Geriatrics Society
Please tell us how you heard about the Effective Health Care Program
From our colleagues at AHRQ, specifically Christine Chang.
Page last reviewed February 2018
Page originally created October 2016

Internet Citation: What are the harms versus benefits for antipsychotics in the prevention of delirium? . Content last reviewed February 2018. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.
https://effectivehealthcare.ahrq.gov/get-involved/nominated-topics/what-are-the-harms-versus-benefits-for-antipsychotics-in-the-prevention-of-delirium-what-are-the-harms-versus-benefits-for-these-drugs-compared-to-the-current-alternative-of-non-drug-approaches-b-what-are-the-harms-versus-be

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