Antipsychotic Drugs Over-Used in Nursing Homes
Nearly 22 percent of elderly residents in U.S. nursing homes regularly receive antipsychotic medications, often without a proper diagnosis to warrant their use. These number are lower than they were a few years ago, but they are still quite significant.
These drugs can be useful, but they can also have significant and sometimes dangerous side effects.
What Are Antipsychotics?
An antipsychotic is a psychiatric medication primarily used to manage psychosis (including delusions, hallucinations, or disordered thought), particularly in schizophrenia and bipolar disorder. Antipsychotics are also used in the management of some non-psychotic disorders.
The three most commonly prescribed antipsychotics are Seroquel, Risperdal and Zyprexa. Others brands are Abilify, Clozaril, Geodon and Symbyax.
Mental health problems are very common in nursing homes. In fact, they are a primary reason that many residents move in. Without medication, these residents might cause harm to themselves, visitors, other residents and caregivers. Some proportion of residents should be on medication for anxiety, depression, bipolar disease, schizophrenia or the behavior problems stemming from dementia.
But other behavior problems can and should be better managed without medication.
Antipsychotics as Chemical Restraints
Nursing home residents can become agitated and difficult for staff to deal with. It is no longer legal to use physical restraints on such patients, except in rare circumstances, so it can be tempting for a nursing home staff member to use antipsychotics as a “chemical restraint” to manage a troublesome resident. The drug is used not to treat medical symptoms, but instead to make the patient easier to manage.
Although the Medicare and Medicaid programs prohibit use of chemical restraints, antipsychotic medications continue to be used as a substitute for good, individualized care. Many believe that usage of chemical restraints has increased as nursing homes hire fewer staff members to work with residents.
Dangers of Antipsychotics in the Elderly
The average person in a nursing home is taking 10 different medications, many of which could interact poorly with antipsychotics. In addition, such medication may sedate residents to the point where they become listless and unresponsive, more confused, or more likely to fall and injure themselves. Usage is linked with certain medical conditions such as respiratory infections and strokes.
Antipsychotics are especially dangerous when they are used for residents with dementia. In 2005, the Food and Drug Administration issued “Black Box” warnings for antipsychotics stating that individuals diagnosed with dementia are at an increased risk of death (60 to 70 percent) from their use. Physicians are advised to discuss this risk with their patients (or their guardians) before prescribing them.
Still, nearly half of patients with dementia are prescribed antipsychotics.
The Centers for Medicare and Medicaid Services launched the “Partnership to Improve Dementia Care” initiative, which was designed to reduce the misuse of antipsychotics among nursing home residents by 15 percent by the end of 2102. This deadline was not met, but officials are hopeful that it will be met by the end of 2013.
In 2012, the Improving Dementia Care Treatment for Older Adults Act was introduced in Congress. It addresses growing costs and concerns about the overuse of antipsychotics in nursing homes and other long-term care facilities. It did not pass the 112th Congress.