The Federal Office of the Inspector General (OIG) released a report in May exposing the widespread misuse of antipsychotic drugs in nursing homes. The OIG l found that “nearly one in seven elderly nursing home residents, nearly all of them with dementia, are given powerful atypical antipsychotic drugs even though the medicines increase the risk of death and are not approved for such treatments...” Even worse, the auditors found that 83 percent of antipsychotic prescriptions for elderly nursing home residents were for uses not approved by federal drug regulators, and 88 percent were to treat patients with dementia - for whom the drugs can be lethal.”
Senator Grassley, who requested the report to evaluate the quality and cost of these drugs in nursing homes focused on the financial impact when he said the report reveals an "astounding waste of taxpayer dollars."
In California, 19% of the deficiencies issued for violations of regulations which harm residents in 2007 were for "Unnecessary Drugs". To put this in perspective, as of 2008 it is estimated that about 1.5 million Americans lived in nursing homes, and about 22% of the 5.3 million people who are 85 or older had a nursing home stay in 2006. There are an estimated 16,000 nursing homes in the United States.
Too often, the families are not told of the risks, benefits and alternatives to these dangerous drugs. They may be embarassed that their loved one is exhibiting strange behavior, and just assume that the doctor would not recommend a drug merely for the convenience of the nursing home staff. Unfortunately, this happens every single day.
As a firm dedicated to improving the lives of California's elderly through advocacy, it is distressing to say how frequently we come across instances of antipsychotic drugs being used on dementia patients. Often times it is a result of an under-staffed skilled nursing facility attempting to subdue or sedate a difficult patient rather than using scarce personnel to provide the necessary supervision and care. Typically, a facility employee will chart their their need to, “calm down”, “relax” or “stabilize” a “stressed out”, “depressed”, “anxious” or “combative” dementia patient - as a justification for use of a psychotropic medication.
And the Doctor? Well he/she is a willing partner in this conspiracy if he/she allows the use of these drugs just to "treat behavior." RED FLAG: Generally, doctors don't "treat" behavior unless the patient has Obsessive Compulsive Disorder, Schizophrenia, or another psychiatric condition where behavior is used to diagnose the condition.
The California Advocates for Nursing Home Reform (CANHR) is one of many stakeholders trying to bring this important issue into the public discussion through education and advocacy. Their fantastic report and information about their Campaign to Stop Chemical Restraints can be found here.
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