Nowadays, in Italy, elderly people represent almost a quarter of the population. Antipsychotics, in this age group, are widely prescribed. Albeit these medications are approved specifically for schizophrenia and bipolar disorders, yet offlabel use of antipsychotics - in dementia, delirium, and other disorders - is recurrent. Literature has extensively highlighted the association between mortality risks and exposure to antipsychotics in elderly people with dementia - as underlined by the publication of the black box warnings from the US Food and Drug Administration - and subsequently taken into account by many other countries. Nonetheless, it remains unclear whether this association is causal, as well as whether it should be applied to elderly patients not suffering from dementia. This study presents a systematic review of the literature (searching MEDLINE and Cochrane Library databases) on the risks of mortality in a geriatric population suffering from psychosis of the schizophrenic and bipolar spectrum, dementia and delirium. The review includes the studies assessing the risk of mortality in elderly persons, aged 65 and over, treated with first and/or second generation antipsychotics. Overall, 25 publications met the inclusion criteria for this systematic review: 3 for psychosis in schizophrenia and bipolar disorder, 20 for dementia and 2 for delirium. Even if the hypothesis of a basic physiopathological mechanism associated with "old age" and involving a greater risk of mortality with the exposure to antipsychotic drugs cannot be discarded, nonetheless the underlying neuropsychiatric disease undeniably has also a specific, positive or negative, influence on this relationship. An accurate assessment of individual risk factors can help clinicians and patients in taking shared decisions on effective, safe, and above all appropriate therapeutic options.
Keywords: Antipsychotics, mortality, elderly, psycho-geriatrics, systematic review