Elderly nursing home residents who take certain antipsychotic drugs for dementia have an increased risk of death, a new study found.

The study of more than 75,000 nursing home residents with dementia, all of whom were 65 or older, found that residents taking the drug Haldol had double the risk of death as those taking Risperdal. The risk was highest during the first 40 days of treatment, according to results published today in the journal BMJ.

"The evidence provided in our study reinforces the important risks associated with the use of these drugs and underscores the need to try alternative means of dealing with behavioral problems in older patients with dementia," wrote study author Krista Huybrechts, an epidemiologist at Brigham and Women's Hospital in Boston. Huybrechts said the use of Haldol "cannot be justified because of the excess harm."

Patients treated with Seroquel appeared to have a decreased risk of death compared with patients taking Risperdal, according to the study.

Previous studies suggest that up to a third of all elderly patients in nursing homes are treated with antipsychotic medications, despite the drugs' limited effectiveness in treating the typical behavioral and psychological symptoms of dementia.

"The types of behaviors that physicians are trying to target with these drugs are aggression, agitation and delusions, which can make patients uncomfortable and lead to behaviors that are harmful to themselves and others," said Huybrechts.  "If the clinician faces a situation in which use of these drugs seems inevitable, our findings underscore the importance of always prescribing the lowest possible dose and of closely monitoring patients, especially shortly after the start of treatment."

Dr. Jenny McCleery, consultant psychiatrist with the Oxford Health NHS Foundation Trust in the U.K. and author of an editorial accompanying the study, said doctors might feel pressured to prescribe antipsychotic drugs in patients who don't need them because of a lack of resources for non-drug-based approaches.

"Clearly, doctors find compelling reasons to prescribe antipsychotics to patients with dementia, reasons that are unlikely to be found in the evidence base alone," she said.

Indeed the practice of prescribing antipsychotic drugs in nursing homes has been linked to suboptimal care.

"The recommendation is to start with non-pharmacological interventions, such as interventions aimed at changing the environment to avoid triggering behavioral problems," said Huybrechts. "But often these non-pharmacological interventions require more resources that are not available, particularly in the nursing home setting."

Huybrechts said she hopes the study highlights the risk of certain antipsychotic drugs among elderly dementia patients and makes doctors think twice about prescribing them.

"I think the decision to treat these patients with antipsychotics is really one that needs to be made based on discussions with the caregiver," she said. "It's important that both parties are aware of risks and benefits so they can make an informed decision."