Concerns have arisen that antipsychotic medication is associated with adverse metabolic effects, such as diabetes, weight gain, and dyslipidaemia. These drugs are used frequently in older people and as many as half of all prescriptions for antipsychotics are estimated to be for people older than 65 years. Furthermore, the incidence of diabetes and other metabolic disorders increases with age. Data from randomised controlled trials and observational studies suggest that the rate of adverse events is lower in older people on antipsychotics compared with younger individuals with schizophrenia. Nevertheless, taking precautions is important when using these drugs in elderly patients. Blood-glucose and lipid profiles should be checked before starting treatment, 3-4 months later, and then yearly.