ABSTRACT
Antipsychotic medications are the pharmacologic agents of choice for treating psychosis in elderly persons. Age-related physiological changes make older persons more sensitive to the therapeutic and toxic effects of antipsychotics. There is a paucity of controlled studies on the efficacy of antipsychotic medications in older persons. Existing data suggest that atypical antipsychotics are at least as efficacious as and better tolerated than the conventional agents. For elderly persons, important adverse effects of antipsychotics include sedating, anticholinergic, and cardiovascular effects, extrapyramidal symptoms, and tardive dyskinesia. Some atypical antipsychotics appear to carry a risk of metabolic changes. Clinical recommendations include a thorough diagnostic evaluation followed by treatment with atypical antipsychotics at low dosages. It is essential that medication be combined with an appropriate psychosocial intervention in order to optimize its effect. Non-antipsychotic medications may provide useful adjunctive or alternative treatment and should be considered on a case-by-case basis.
Subject(s)
Antipsychotic Agents/therapeutic use , Psychotic Disorders/drug therapy , Aged , Aging/metabolism , Antipsychotic Agents/adverse effects , Antipsychotic Agents/pharmacokinetics , Female , Humans , Male , Practice Guidelines as Topic , Treatment OutcomeABSTRACT
In the population of older adults, anxiety disorders are underdiagnosed and undertreated. Epidemiologic studies have generally found that the prevalence of anxiety disorders declines with age. Recognition of anxiety disorders in older adults is, however, complicated by several age-related factors including the presence of depression, cognitive impairment, and physical illness. A variety of medications have been used to treat anxiety disorders across the life span; however, few studies have evaluated their use specifically in older adults. Choice of medication requires consideration of the effects of aging on safety, tolerability, and adherence. Available data suggest that cognitive and behavioral treatments may be effective for anxiety disorders in older adults. Appropriate medical evaluation and psychosocial interventions are recommended prior to initiating pharmacotherapy. When pharmacologic treatment is warranted, antidepressant medications at low doses may be useful for late-life anxiety disorders; other agents may be considered for augmentation or second-line use in certain types of patients.
