Atypical antipsychotics for nursing home patients: a retrospective chart review

To compare the efficacy and safety of risperidone and olanzapine in the treatment of psychotic symptoms and behavioural disturbances in institutionalised patients with dementia and other psychiatric disorders.

We conducted a retrospective chart review of nursing home patients with psychiatric disorders or dementia in 65 long-term care facilities in New Jersey and Pennsylvania who had received treatment with risperidone or olanzapine. We determined the efficacy of the two antipsychotics for the treatment of psychotic symptoms or behavioural disorders in patients with dementia, the incidence of falls in ambulatory patients, and the incidence of adverse events in the total sample of patients.

A total of 289 long-term care patients were included in the analysis. Diagnoses included dementia in 59%, schizophrenia in 20%, bipolar disorder in 8%, schizoaffective disorder in 6% and other diagnoses in 10%. The mean ages were 77 years in patients receiving risperidone and 81 years in patients receiving olanzapine. Risperidone was received by 141 patients and olanzapine by 148 patients. In the 171 patients with dementia, significantly greater improvements in psychotic symptoms and behavioural disturbances were seen in patients receiving risperidone compared with those receiving olanzapine (p < 0.05). In the 222 ambulatory patients, > or = 1 fall was recorded in 19% of patients receiving risperidone and in 38% of patients receiving olanzapine (p = 0.001). The fall rate per month was 0.06 in risperidone recipients and 0.17 in olanzapine recipients (p < 0.001). Adverse events were reported in 6% (9/141) of risperidone-treated patients compared with 34% (42/110) of olanzapine-treated patients (p < 0.001). Adverse events seen only in the olanzapine group were constipation, dry mouth, dysphasia, sedation and dizziness.

The results of this review indicate that risperidone was more efficacious and better tolerated than olanzapine in the treatment of nursing home patients with psychotic symptoms and behavioural disturbances.