Antipsychotic drugs such as Risperdal, Seroquel, and Thorazine for mania and schizophrenia are often given to elderly people with dementia to temper their sometimes strange or aggressive behavior. Up to 25 percent of Medicare beneficiaries in nursing homes, in fact, are thought to be taking at least one antipsychotic. And that may put them at a heightened risk of death.

It has been known for some time that certain antipsychotics pose a risk to people with dementia; last April, the Food and Drug Administration issued a warning about newer drugs, including Risperdal and Seroquel, prompting questions by some clinicians about whether they should switch back to older drugs such as Thorazine and Haldol that can have worse side effects. But the older drugs could pose even greater risks, according to a report in this week's New England Journal of Medicine. Says lead researcher Philip Wang, a psychiatrist at Brigham and Women's Hospital in Boston: "People should not be switched from newer drugs to older or be casually prescribed these drugs."

The researchers looked at insurance and Medicare data from nearly 23,000 patients older than 64 who got antipsychotic drugs. They analyzed the number who died within six months of receiving a prescription for either a newer or older drug and found that those who took the older antipsychotics had a 37 percent higher risk of death than those who received the newer generation of drugs. (Previous studies have suggested that people on the newer drugs are 60 to 70 percent more apt to die that those taking a placebo.) The researchers say they could not tell what caused those deaths, though previous studies have shown that the drugs can cause heart problems or pneumonia.

Wayne Ray, an epidemiologist from Vanderbilt University who wrote a perspective on the study in the same issue of the journal, says that the drugs are often used because nursing home staff or family members have trouble dealing with elderly patients' behavior issues. He says that there are often other solutions, including dealing with the problem underlying the behavior or trying to make the patient calm down without medication.

"In the opinion of many researchers in the area," says Ray, antipsychotics "should be avoided unless there is no other option."