| Course | NUR-7600 Psychopharmacology and Neuroscience Foundations Across the Lifespan |
|---|---|
| Module | Module 5 |
| Paper type | Prescribing case: adverse events and deprescribing in older adults |
| Length | About 1,013 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7600 Module 5
One Death for Every 27 Treated: The Boxed Warning, Absolute Risk and a Four-Week Risperidone Taper for an 86-Year-Old With Alzheimer Disease
Student Name
M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University
NUR-7600: Psychopharmacology and Neuroscience Foundations Across the Lifespan
Mentor Name
Month Day, Year
One Death for Every 27 Treated: The Boxed Warning, Absolute Risk and a Four-Week Risperidone Taper for an 86-Year-Old With Alzheimer Disease
Introduction
Mrs. E. is an invented patient, an 86-year-old former bookkeeper with moderate Alzheimer disease who lives in an assisted living residence in Morristown. Eight months ago, during a urinary tract infection, she became agitated one evening, shouted at staff and tried to leave the building. A covering clinician started risperidone 1 milligram at bedtime, and it has been continued since. The infection was treated within days. She now spends most of the day quietly, sometimes dozing in her chair, and has fallen twice in three months. Staff report that she becomes restless in the late afternoon, pacing and asking for her late husband. Her son asks whether the medicine is still needed. This paper reviews the risks of continuing and plans the next step.
The Boxed Warning
Every antipsychotic label warns, in a black box, that older people with dementia who take these drugs die more often. The warning followed analyses of placebo-controlled trials. Schneider et al. (2005) combined 15 placebo-controlled dementia trials of newer antipsychotics: 3.5 percent of those on a drug died during the trials against 2.3 percent on placebo, odds about half again as high. Deaths were mostly from cardiovascular causes, such as heart failure and sudden death, or infections, mostly pneumonia. The trials were short, about 10 to 12 weeks, so the long-term risk was not measured.
The Risk in Real Practice
Trials enroll selected patients for a few weeks. Observational studies show what happens in practice over longer periods. Gill et al. (2007) matched more than 27,000 pairs of older Ontarians with dementia and saw more deaths within a month among new users of the newer antipsychotics, at home and in nursing homes alike, with the gap widest in nursing homes. Conventional antipsychotics were associated with higher risk still. The authors noted that unmeasured confounding could affect their estimates.
Maust et al. (2015) expressed the risk in a form that is easier to use with families. In a cohort of veterans with dementia, compared with matched nonusers, risperidone was associated with an absolute increase in mortality of 3.7 percentage points over 180 days, a number needed to harm of about 27. Haloperidol had a similar number, olanzapine about 40 and quetiapine about 50. Risk increased with dose.
These are observational numbers, and people who are given antipsychotics may be sicker or more agitated than those who are not in ways no adjustment fully captures. Even so, the trials, the population cohort and the veterans cohort point in the same direction, and the consistency across designs makes the risk hard to dismiss.
| Source | Design | Key finding |
|---|---|---|
| Schneider et al. (2005) | Meta-analysis of 15 placebo-controlled trials | Death 3.5 percent with drug, 2.3 percent with placebo |
| Gill et al. (2007) | Population cohort, more than 27,000 matched pairs | Higher 30-day mortality with new use |
| Maust et al. (2015) | Veterans cohort | Risperidone number needed to harm about 27 |
Weighing Benefit Against Harm
The benefit of risperidone for Mrs. E. is uncertain. It was started for agitation during delirium from an infection, a temporary cause that has resolved. Her current pattern, quiet days with daytime drowsiness, two falls and late-afternoon restlessness, suggests that the drug may now be causing harm through sedation and falls without treating a continuing problem. Her late-day restlessness, often called sundowning, is common in dementia and often responds to changes in routine, light and activity. Guidance for antipsychotics in dementia generally supports attempting to taper and stop them when they were started for a time-limited problem or after a period of stability, with careful observation for return of severe symptoms.
The Taper
Risperidone is reduced from 1 milligram to 0.5 milligrams at bedtime for two weeks, then to 0.25 milligrams for two weeks, then stopped. Staff record agitation, sleep and falls daily with a simple behavior log. If severe distress or danger to herself or others returns, the previous dose is resumed while the cause is investigated.
Nondrug Care for Late-Day Restlessness
The residence's staff and her son are involved in a plan built on assessment of what triggers her restlessness. A walk outdoors in the early afternoon, brighter lighting in the late day, a familiar task such as sorting buttons or folding towels, playing music from her young adulthood and a regular visit or phone call from her son at 4 p.m. are introduced. Pain, constipation, hunger, a full bladder and hearing or vision problems are checked, since unmet needs often drive agitation in people who cannot describe them. A nurse reviews her medication list for other sedating drugs.
She also takes oxybutynin for bladder urgency, a strongly anticholinergic drug that can worsen confusion and add to fall risk in older adults. The nurse practitioner will raise with her primary care provider whether a bladder routine or a different medicine could replace it, since removing one sedating drug while leaving another would only half solve the problem.
Talking With Her Son
Her son is told plainly that the medicine was started for a short-term problem that has resolved, that it carries a warning about increased risk of death in people with dementia, and that for every 27 people with dementia who take it for six months, about one additional person dies who would not otherwise have died. He is told that it may also be contributing to her drowsiness and falls, that the plan is to reduce it slowly while improving her afternoon routine and that it can be restarted if she becomes severely distressed. His questions and agreement are documented.
Conclusion
Risperidone was started for Mrs. E. during a temporary delirium and continued without review. Trial and cohort evidence show an increased risk of death with antipsychotics in dementia, about one additional death for every 27 people treated with risperidone in one cohort, and her falls and drowsiness suggest harm without clear benefit. A four-week taper, nondrug care for her late-day restlessness and a clear conversation with her son replace the drug with a plan.
References
Gill, S. S., Bronskill, S. E., Normand, S.-L. T., Anderson, G. M., Sykora, K., Lam, K., Bell, C. M., Lee, P. E., Fischer, H. D., Herrmann, N., Gurwitz, J. H., & Rochon, P. A. (2007). Antipsychotic drug use and mortality in older adults with dementia. Annals of Internal Medicine, 146(11), 775-786. https://doi.org/10.7326/0003-4819-146-11-200706050-00006
Maust, D. T., Kim, H. M., Seyfried, L. S., Chiang, C., Kavanagh, J., Schneider, L. S., & Kales, H. C. (2015). Antipsychotics, other psychotropics, and the risk of death in patients with dementia: Number needed to harm. JAMA Psychiatry, 72(5), 438-445. https://doi.org/10.1001/jamapsychiatry.2014.3018
Schneider, L. S., Dagerman, K. S., & Insel, P. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: Meta-analysis of randomized placebo-controlled trials. JAMA, 294(15), 1934-1943. https://doi.org/10.1001/jama.294.15.1934
NUR 7600 Module 5 instructions, in plain terms
Harm from a drug, and how it differs by population, is a thread in TESU's course description; this fifth module, planned without a public syllabus, follows that thread to an 86-year-old in assisted living. Expect a case paper that identifies a drug-related risk, reviews the evidence on its size, weighs benefit against harm for the specific patient, communicates the risk in plain terms and writes a plan, often a deprescribing plan with monitoring. Some classrooms set a case of serotonin syndrome, QT prolongation or anticholinergic burden instead. Check the directions. Express risks in absolute terms where you can, and plan what will replace the drug's function if you stop it. Check the whole medication list for other drugs that add to the same harm.
How the NUR 7600 Module 5 example is put together
The paper begins with an 86-year-old in assisted living still taking risperidone eight months after a night of delirium, now drowsy and falling. The boxed warning is explained with pooled trial rates, and a margin note explains why absolute rates matter. A population cohort and a veterans cohort show the risk in practice, the latter as a number needed to harm, with a three-row table. Benefit and harm are weighed for her. A four-week taper with a behavior log follows, then a specific nondrug plan for late-day restlessness. A section models the conversation with her son, and the conclusion summarizes the decision.
Where the marks sit in the NUR 7600 Module 5 rubric
Adverse event cases are graded on accurate description of the risk and its evidence, use of absolute as well as relative measures, a patient-specific weighing of benefit and harm and a safe, specific plan. Ask why the risperidone was started and whether that reason survives today. Deprescribing plans should include a taper schedule, monitoring and a plan for return of symptoms. Nondrug alternatives should be concrete. Communication with the family in plain language, including a number needed to harm, shows skill. Current and landmark sources and APA formatting complete the grade. Scanning the whole list for other sedating or anticholinergic drugs, like her oxybutynin, often moves a paper into the top band.
NUR 7600 Module 5 help from the desk
Students often cite the boxed warning without describing the size of the risk. Give absolute rates or a number needed to harm. Another weakness is stopping a drug without a taper or without replacing what it was meant to do, which leads to the drug being restarted. Find out why the drug was started. Plan nondrug care specifically, with times and activities. Watch for other sedating drugs. Write the family conversation in plain words. Document what would prompt restarting, and look for other sedating or anticholinergic drugs on the list. Involve staff who see the patient every day. If your NUR-7600 prompt centers on a drug harm, send it with the patient details and a first draft arrives free.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7600 Module 5 questions, answered
Where can I find a free NUR 7600 Module 5 sample paper?
The taper paper sits above in full. It tapers risperidone in an 86-year-old with Alzheimer disease, using the boxed warning and a number needed to harm.
Why do antipsychotics have a boxed warning in dementia?
Because short trials pooled by the FDA's reviewers and later researchers showed extra deaths, chiefly from heart problems and pneumonia, among people with dementia on these drugs.
What is the number needed to harm for risperidone in dementia?
In one veterans cohort, about 27 over 180 days, meaning one additional death for every 27 people with dementia treated compared with matched nonusers.
How do you taper an antipsychotic in dementia?
Reduce the dose stepwise over several weeks, for example halving it every two weeks, while logging behavior and sleep and resuming if severe distress returns.
What helps late-afternoon agitation in dementia without drugs?
Daytime activity and light, a familiar task, music, regular contact with family and checking for pain, hunger, constipation, bladder needs and sensory problems.