Expert Consensus Guidelines for Using Antipsychotic Agents in Older Patients

In the United States, there are about 2600 boardcertified geriatric psychiatrists but over 35 million elderly people. Thus, many elderly patients with psychiatric conditions are treated solely by primary care physicians or general psychiatrists, some of whom may not have received training sufficient for addressing the needs of the elderly population. Although randomized clinical trials remain the gold standard upon which to base clinical guidelines, these trials do not cover all aspects of clinical practice that physicians may face.

The goal of the Expert Consensus Guidelines: Using Antipsychotic Agents in Older Patients is to answer clinical questions that are not adequately addressed by research on the use of antipsychotics in older patients. The survey on which these Guidelines are based had 3 main goals: (1) to identify geriatric disorders for which antipsychotic treatment is inappropriate because of the increased risk of undesirable side effects or a lack of any clear therapeutic benefit; (2) to identify the indications for antipsychotics in the elderly, as well as appropriate dosages and duration of treatment; and (3) to determine under what conditions (i.e., comorbid disorders, concomitant medications) diseasedrug and drug-drug interactions are most likely to occur with antipsychotic treatment. The survey on which the Guidelines are based was completed by 48 leading experts in the field of geriatrics (geriatric psychiatrists and geriatric internists/family physicians) who were asked about current best clinical practice. This commentary highlights selected important results of the survey.’ ‹’ ‹