Antipsychotic Use As Chemical Restraints Decline: Government Report

A new report indicates that a federal and private health care coalition is making headway in reducing the amount of antipsychotics given to nursing home residents with dementia, which are often used as a form of “chemical restraint” to control difficult behavior. 

The National Partnership to Improve Dementia Care in Nursing Homes issued a report (PDF) on July 27, showing that the use of nursing home antipsychotic use for dementia patients has dropped by more than a fifth over the last four years.

Antipsychotic medications like Risperdal, Zyprexa, Seroquel and others may pose serious risks when prescribed for “chemical restraint”. In many cases, patients receiving these medications in nursing homes suffer from dementia, and studies have shown that antipsychotics not only provide no benefits for dementia patients, but could increase their chance of dying.

The Department of Health and Human Services (HHS), in conjunction with other federal agencies and private groups, is already battling antipsychotic drug use in nursing homes through the National Partnership to Improve Dementia Care and other efforts.

In September 2014, the National Partnership to Improve Dementia Care announced that it has set a goal of reducing the use of antipsychotics in long-term care facilities by 25% before the end of 2015. The group, headed by the Centers for Medicare and Medicaid Services (CMS) hopes to see reductions of 30% by the end of 2016.

The latest report was generated by CMS, which reviewed publicly reported measures, and tracks the use of antipsychotics in nursing homes from the fourth quarter of 2011 through the first quarter of 2015.

“In 2011 Q4, 23.9% of long-stay nursing home residents were receiving an antipsychotic medication; since then there has been a decrease of 21.7% to a national prevalence of 18.7% in 2015Q1,” the report states. “Success has varied by state and CMS region, with some states and regions having seen a reduction of greater than 20%.”

Hawaii had the lowest rate of antipsychotic use suspected of being chemical restraints, while Texas had the worst record, even though that state saw a 19.7% drop in chemical restraint use in recent years.

The report comes just a month after the Obama administration and CMS proposed the first nursing home regulatory reforms in a quarter of a century. If approved, the reforms would ban the use of any physical or chemical restraints that are not specifically prescribed to treat medical symptoms as part of a package of reforms titled “Freedom from Abuse, Neglect, and Exploitation.”

The 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. Given what is known about the potential side effects of antipsychotics, use of the medications is often considered a form of elderly abuse when the purpose is to sedate the individual, rather than treat.