Abrupt or gradual discontinuation of antipsychotics in older adults with dementia reduces delirium and fracture risk without increasing mortality, stroke, or pneumonia risk. This finding challenges the assumption that prolonged antipsychotic use is necessary for safety in this population and supports de-prescribing when treatment duration exceeds clinical guidelines.
Key Points
- Antipsychotic discontinuation lowers delirium and fracture risk significantly
- Stopping antipsychotics does not increase death, stroke, or pneumonia
- Both abrupt and gradual tapering show comparable safety profiles
Longevity Analysis
Prolonged antipsychotic exposure in older adults with dementia represents a form of pharmacological interference that generates measurable harm—delirium and fractures—without providing the protective benefit assumed to justify continuation. The ability to safely discontinue these medications when guideline duration is exceeded reframes medication management as a process of active elimination rather than passive maintenance. For individuals with dementia, removing a cognitive and physical stressor through evidence-supported de-prescribing can reduce acute complications and preserve functional capacity, key determinants of both health span and decision-making capacity in later life.
Original published by The Lancet Healthy Longevity, by Olivia K Hopkinson, Jan Chobanov, Darshna Goordeen, Kenneth K C Man, Ian C K Wong, Emily Reeve, J Simon Bell, Li Wei, Robert Howard, Wallis C Y Lau.