Wei’s research into antipsychotic prescriptions among the elderly has focused on their comparative fall and fracture risk with other commonly prescribed psychotropic prescriptions like antidepressants, as well as the impact of inappropriate antipsychotic prescribing on mortality risk.
In one of Wei’s studies, she compares the risk of falls and fractures among Alzheimer’s patients prescribed antipsychotics versus those prescribed antidepressants.
Prescribing antipsychotics to Alzheimer’s patients is not FDA-approved and is a controversial issue as 179,000 nursing home patients continue to receive these drugs every week, according to Human Rights Watch. These drugs are incorrectly used as a sedative to reduce calls for help and to calm behavior, Wei said. As antipsychotics have been highly scrutinized, many prescribers turn to antidepressants that also have sedative properties.
Yet using Medicare claims data, Wei’s research found that prescribed antidepressants are associated with higher fall and fracture risk compared to antipsychotics in the management of older adults with Alzheimer’s disease and related dementia who experience moderate to severe behavioral symptoms.
Wei recommends clinicians assess the ongoing risks and benefits of antidepressants for these symptoms, especially in light of the increasingly prevalent use of these medications.
In another study, Wei examined mortality rates and antipsychotic medication. Through a 5 percent random sampling of Medicare beneficiaries, Wei’s team found that mortality risk increases when patients with serious mental illnesses are inappropriately prescribed higher than recommended antipsychotic doses on short-term regimens.
The mortality risk decreases when prescribed within recommended dose ranges on long-term regimens. The greatest difficulty with this long-term treatment is getting patients to adhere to instructions.
Wei recommends prescribers monitor antipsychotic dosage throughout the course of treatment and customize dose and duration regimens to an individual’s indications.
Her future studies will address pain control approaches that consider and manage mental health problems in older adults with ADRD.