Olanzapine is as sedating as risperidone, has somewhat more anticholinergic effects, but is less likely to lead to orthostatic hypotension. In contrast, thioridazine is especially troublesome for patients with postural hypotension, and haloperidol may cause significant parkinsonian symptoms. In treatment-resistant patients and in those with severe psychosis, clozapine is a possible choice. There has been little cumulative experience with clozapine in the elderly, although evidence indicates a higher incidence of agranulocytosis. Most elderly patients are willing to take an antipsychotic drug if they are told that the drug will also help improve sleep and alleviate anxiety.
Compliance is often problematic but less so in later life than earlier.
Even paranoid persons usually trust their physicians and are willing to comply with therapy. If the elderly patient objects, family members may be able to help. A strong objection to drugs or other interventions may suggest the need for hospitalization if symptoms are severe. Some elderly patients who have had long-standing schizophrenia may no longer need antipsychotic treatment. At least one trial of discontinuation should be attempted but only when close supervision is possible.