Concerns Over Antipsychotic Drug Use Rise

Nearly 2,500 nursing home residents in one state were given powerful antipsychotic drugs last year that were not intended or recommended for their medical condition, a practice that is more common here in some states than in others. Research by the federal Centers for Medicare and Medicaid Services shows that 22 percent of 28 percent of residents in the state being given antipsychotics did not have a medical condition that calls for such treatment.

The use of such drugs is especially worrisome in nursing homes because a substantial number of residents suffer from dementia which puts them at greater risk of death when given antipsychotic medications. The drugs, also known as “‘psychotropics,’’ were developed to treat people with severe mental illnesses such as schizophrenia. Twice in the past five years, federal regulators have issued nationwide alerts about troubling and sometimes fatal side effects when antipsychotics are taken by people with dementia, including increased confusion, sedation, and weight gain.

As the nation ages - up to 14 million baby boomers are expected to develop Alzheimer’s disease or a similar dementia - the drugging of such vulnerable patients takes on increasing urgency. While there has been much focus on the increasing use of antipsychotic drugs among children- highlighted by the recent overdose death of 4-year-old Rebecca Riley- much less attention has been paid to the similar problem among seniors.

“Way too many patients in nursing homes are treated with antipsychotics purely to sedate them or to control behaviors that are difficult for the staff,’’ said  an Alzheimer’s specialist and brain researcher at Boston University School of Medicine.

“To the defense of nursing homes and nursing home staff,’’ the alzheimer's specialist said, “they are indeed understaffed, they are indeed under-trained, and it takes an awful lot of well-trained people to manage the difficult behaviors that can be exhibited by people with dementia.’’

Specialists say antipsychotics can improve the quality of life for some dementia patients who suffer from extreme agitation and sleeplessness, common symptoms of Alzheimer’s. But too often nursing homes don’t regularly reevaluate patients’ medications to determine whether the antipsychotics are, in fact, effective and whether the dose can be lowered or eliminated, said psychologist and vice president of clinical services for the Massachusetts and New Hampshire Alzheimer’s Association.

The state’s top nursing home regulator as director of the Bureau of Health Care Safety and Quality, said “culture change,’’including a growing consumer movement that focuses on more closely involving families and patients in care decisions, can lower the use of psychotropic drugs. “We can do better, and use fewer drugs, and do more with behavioral interventions by changing the way we deliver care in nursing homes,’’she said. Her agency is developing a brochure for nursing homes to give new residents and their families, encouraging them to ask about the medications prescribed. For more, read the story.

Robert W. Carter,Jr. is a Virginia attorney whose law practice is dedicated to protecting the rights of the victims of nursing home and assisted living neglect and abuse in Richmond, Roanoke, Norfolk, Lynchburg,Danville, Charlottesville, and across Virginia.

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