Too Many Antipsychotics Still Prescribed to Dementia Patients: GAO Report

Widespread overuse of antipsychotic medications continues to be a problem, especially among elderly dementia patients for whom the drugs may increase the risk of death, according to a new government report. 

The U.S. Government Accountability office (GAO) released a new report (PDF) on March 2, urging the government to expand current efforts to reduce the use of antipsychotics among elderly nursing home residents.

The report finds that about one-third of elderly dementia patients who spent more than 200 days in a nursing home in 2012 were given antipsychotic medications, which include drugs like Risperdal, Seroquel, Zyprexa and others.

Antipsychotic medications are often used in appropriately as a form of chemical restraint in nursing homes, sedating residents that are difficult to manage. In many cases, these patients suffer from dementia, and studies have shown that not only do antipsychotics 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 hopes to see reductions of 30% by the end of 2016.

Founded by the U.S. Centers for Medicare and Medicaid Services (CMS), a division of HHS, the group’s efforts have already seen a reduction in use of antipsychotics in nursing homes by 17.1% over the previous 21 months before the September report. The group said that all 50 states showed some improvement over that period.

However, the GAO report says that the efforts need to be ramped up considerably, particularly to elderly who are not in nursing homes.

“Agencies within the Department of Health and Human Services (HHS) have taken several actions to address antipsychotic drug use by older adults in nursing homes, as described in HHS’s National Alzheimer’s Plan,” the GAO report notes. “GAO recommends that HHS expand its outreach and educational efforts aimed at reducing antipsychotic drug use among older adults with dementia to include those residing outside of nursing homes by updating the National Alzheimer’s Plan.”

Use of atypically antipsychotic medications as a form of chemical restraint is often considered a form of nursing home abuse, and the practice has become even more troubling following FDA warnings that indicate the medications may pose serious health risks and death for dementia patients.

The GAO report found that patient agitation, delusions, and certain setting-specific characteristics led to the use of antipsychotics as chemical restraints. The report found that the lower nursing home staff levels are, the higher the likelihood of unnecessary antipsychotic prescriptions to dementia patients.

The Department of Justice (DOJ) has previously accused Johnson & Johnson of engaging in kickback schemes designed to convince doctors to prescribe their antipsychotic medication Risperdal to elderly nursing home patients, knowing that the drug was being used abusively and potentially placing patients’ at risk of death.

In November 2013, Johnson & Johnson agreed to pay $2.2 billion to the federal government to settle its Risperdal illegal marketing claims.