Efforts to Prevent Use of Chemical Restraints in Assisted Living Fail, Even As Nursing Home Use Drops: Study

A federal program failed to reduce the unnecessary use antipsychotic medications among seniors with dementia in assisted living facilities, even though the same tactics were effective at reducing the incidence using the drugs as a form a chemical restraints in nursing homes, according to new research.

In findings published this month in the Journal of the American Geriatrics Societym researchers from University of Michigan and Brown University indicate a program used to reduce inappropriate prescriptions of antipsychotic drugs worked in long-term care facilities, but did not have the same success for assisted living facilities.

Past research has shown antipsychotics use among dementia patients not only provides no treatment benefits, but could increase their risk of dying. The U.S. Food and Drug Administration (FDA) has previously warned against the use of antipsychotics with dementia patients, indicating that the medications provide no benefits and may increase the risk of death. This tactic of pacifying dementia patients with drugs is known as “chemical restraint” and is often considered a form of nursing home abuse.

In this new report, researchers conducted a retrospective cohort study involving nearly 108,000 beneficiaries with dementia who had more than one month as an assisted living resident, and 323,000 beneficiaries with more than one month as a long-stay nursing home resident with dementia.

Researchers used data from the Centers for Medicare & Medicaid Services after the National Partnership to Improve Dementia Care in Nursing Homes program was implemented to decrease antipsychotic use and improve care for nursing home residents with dementia. This study included a sample of 20% of fee-for-service Medicare beneficiaries with Part D.

Overall, the program led to a decrease in antipsychotic prescribing during the study among both populations within four years after the launch of the effort in 2012. However, while the partnership program led to a 30% reduction in antipsychotic medication use among nursing home residents, incidents of chemical restraint among assisted living facilities began to increase.

There was also a slight increase among mood stabilizer and anticonvulsant medication prescribing among assisted living residents. This was especially true for gabapentin, sold under the brand names Gralise, Horizant, and Neurontin.

“The federal Partnership to reduce antipsychotic prescribing in NH residents did not appear to affect antipsychotic prescribing in AL residents with dementia,” the researchers concluded. “Given the increase in the prescribing of mood stabilizers/anticonvulsants that occurred after the launch of the Partnership, monitoring may be warranted for all psychotropic medications in AL and NH settings.”

Nursing Home Chemical Restraint Concerns

The Food and Drug Administration (FDA) has previously warned against the use of antipsychotics among dementia patients, indicating that the medications provide no benefits and may increase the risk of death.

The agency issued a black box warning for chemical restraint drugs in 2005. While the warning led to reduced use of the drugs, it also increased the use of other types of medications, like hypnotics, antiepileptics and opioids, that also increased the risk of cardiovascular events among seniors.

A recent study indicated chemical restrain drugs are being used less often, but the replacements, such as opioids and antidepressants, are being used more and those may also pose other side effects to seniors.

When used improperly, instead of when patients may harm themselves, chemical restraint drugs can lead to unnecessary side effects, such as bed sores, physical injuries, falls, fractures and in some cases death. When used in inappropriate ways it is considered nursing home abuse.