A recent study conducted by the University of Oulu and the University of Eastern Finland has found that off-label use of antipsychotic medications is widespread among older adults in Finland. Off-label use refers to doctors prescribing medications for purposes other than those officially approved.
Researchers analyzed national registry data from 209,346 older adults living at home who did not have Alzheimer’s disease. The study divided participants into three groups: those using antipsychotics off-label, those using them for approved indications (on-label), and those not using antipsychotics.
The findings indicate that 70 percent of all antipsychotic use was off-label. The prevalence of off-label use increased toward the end of the follow-up period. Risperidone and quetiapine were identified as the most commonly used antipsychotics for off-label purposes.
Antipsychotics are often prescribed to older patients to manage prolonged behavioral symptoms or insomnia, despite lacking official approval for these uses. Previous literature has raised concerns about such practices, especially when non-drug treatments are unavailable, suggesting it could be considered a form of elder abuse. The study notes that reduced resources in elderly care services and limited access to non-pharmacological interventions have contributed to greater reliance on medication.
The research also found that individuals using antipsychotics off-label had higher rates of cardiovascular diseases and cerebrovascular disorders compared with other groups. Additionally, they showed higher opioid use.
According to Majuri, "this finding may reflect that monitoring of the metabolic side effects of medications is currently insufficient in off-label use."
The authors suggest there is a need for alternative treatment options for conditions currently managed with off-label antipsychotic prescriptions.
"Clearer guidelines are needed for monitoring the metabolic side effects of off-label antipsychotic use, as well as measures to promote safer prescribing practices," Majuri stresses.
The research received funding from the Päivikki and Sakari Sohlberg Foundation and the Research Council of Finland.
