Risks and Benefits of Prescription Psychostimulant Use among Older Adults

Abstract

Prescription psychostimulant use among older adults has increased in recent years, raising important questions about their safety and efficacy in this population. Chapter 1 introduces this growing trend in the United States and highlights the need for research to inform safe prescribing practices. Chapter 2 presents a scoping review of the literature, identifying potential benefits of stimulants for on-label indications (e.g., attention-deficit/hyperactivity disorder, narcolepsy), as well as off-label uses including depression, apathy, fatigue, dementia, Parkinson’s disease, and post-stroke motor recovery. However, significant potential risks are also noted, particularly adverse cardiovascular events and neuropsychiatric complications. Chapter 3 explores the prevalence and sociodemographic characteristics of prescription stimulant use disorder among community-dwelling U.S. civilians, finding that very few individuals with stimulant use disorder were aged 65 or older. Chapter 4 uses a target trial emulation approach to compare the cardiovascular safety of amphetamines and methylphenidates—the two major stimulant classes—among older adults. Results show that methylphenidate initiation is associated with a higher risk of major adverse cardiovascular events (myocardial infarction, stroke/transient ischemic attack, ventricular arrhythmia, and mortality) compared to amphetamine initiation. Conclusions and implications for practice are discussed in Chapter 5