Nursing Home Antipsychotic Drug Use Often Unnecessary: Study

Federal investigators say that in recent years a little more than half of the antipsychotic medications prescribed in nursing homes were given to patients with dementia, who should not be given the powerful drugs. Use of the drugs is believed to have been spurred on by illegal kickback schemes from drug makers or as a form of chemical restraint by the nursing homes, despite the risk that use of antipsychotics could kill dementia patients. 

Last week the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) released a report on atypical antipsychotic misuse in nursing homes.

Researchers say that 51% of prescriptions for drugs like Seroquel, Risperdal and Zyprexa in nursing homes during the first half of 2007 were given to dementia patients despite the known side effects of atypical antipsychotics. Taxpayers shelled out $116 million for the largely unnecessary prescriptions.

The powerful drugs are not approved for treatment of dementia, and the FDA has repeatedly warned that they should not be used to treat dementia patients, as the medications may increase the risk of death and many experts say that they do nothing to actually treat dementia.

Many critics have argued that the wide “off-label” prescriptions for nursing home dementia patients is really a form a “chemical restraint” for hard-to-manage residents, which is widely regarded as a form of nursing home abuse.

The HHS-OIG report took data collected by the U.S. Centers for Medicare and Medicaid Services (CMS) in the first half of 2007 and found that 14% of the nation’s 2.1 million elderly nursing home residents were prescribed atypical antipsychotics at least once. Medical records indicate that 83% of those drugs were given for “off-label” reasons which were not approved by the FDA. About 88% of the off-label uses were for conditions that the FDA cautioned against in black box warnings, the strongest label advisory the agency can give. The FDA warnings date back to 2005.

The HHS-OIG recommends that to prevent future abuses the CMS could use diagnosis information to ensure that it was not paying nursing homes to pharmaceutically abuse their residents. The report also includes recommendations that CMS analyze whether survey and certification processes can be changed to safeguard against the problems in the future and then hold nurses accountable when they distribute antipsychotics for the wrong reasons. The report also urged CMS to look at what other actions it can make to force compliance, and that the agency take action on the specific claims of misuse detailed in the report.

While CMS officials said they agreed with most of the recommendations, the agency stated it is impossible to determine whether the drug reimbursement claims meet payment requirements in a timely manner because diagnosis information is not required in pharmacy billing transactions and is not made part of the prescription.