Antipsychotic Drug Use in Dementia Care Targeted by CMS, Watchdogs

As new guidelines begin to take effect that are aimed at reducing the overuse of antipsychotics among the elderly and nursing home residents, a prominent watchdog group has published a list of recommendations for consumers and their family members, outlining what to do to avoid unnecessary antipsychotic prescriptions for dementia.  

In the latest issue of the Public Citizen newsletter Worst Pills, Best Pills (subscription required), the consumer advocacy group highlights new guidelines issued in May by the Centers for Medicare and Medicaid Services (CMS) that target the abuse of antipsychotic prescriptions in dementia care.

Often given to treat dementia, or used as a form of chemical restraint, research has found that not only do the drugs not treat dementia, but they increase the risk of death among elderly patients. Unnecessary use of these drugs is often considered a form of nursing home abuse, and can have serious impacts on the overall health and quality of life for residents.

The new guidelines were developed as part of the National Partnership to Improve Dementia Care in Nursing Homes, and are designed to cut down on the use of drugs like Risperdal, Seroquel, Abilify, Zyprexa, Geodon and others.

To date, efforts to fight their use has helped, but not as much as health care experts would like. According to the CMS the use of prescribed antipsychotics in nursing homes has dropped about 9% from 2011 to 2013, but the agency had been hoping for a 15% decrease by the end of 2012.

Public Citizen warns that patients and their families should not wait for the problem to fix itself and should take precautions against unnecessary antipsychotic prescriptions by doing the following:

• Realizing that the use of these drugs among elderly patients can increase the chances of death and other serious side effects.
• Talking to your doctor about why the drug has been prescribed and making a plan to reduce or stop use of the medication.
• Discussing other treatment options, including an increase in skilled nursing care.
• Exploring how to reduce medication use instead of adding more drugs when a patient is doing poorly whole in psychoactive medications.

Antipsychotic Overuse and Risks

Much of the problem surrounding the overuse of antipsychotics in nursing homes is linked to inadequate staffing, which leads some employees to take the easy way out and sedate residents with drugs.

In May 2011, the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) issued a report on atypical antipsychotic misuse in nursing homes, which found off-label and dangerous use of the drugs was widespread.

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 that 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.

Not only are the antipsychotics dangerous, but they are expensive as well, according to CMS. They cost Medicare $7.6 billion in prescription reimbursements in 2011 alone.