Reduced Use of Antipsychotics for Dementia Does Not Improve Outcomes for Nursing Home Residents: Study

Study suggests nursing home residents taken off antipsychotics were given more antidepressant, anxiety, sedative, anticonvulsant, mood stabilizer and anti-dementia medications.

Nursing homes nationwide have been warned repeatedly by federal health officials against the overuse of antipsychotic medications, which are commonly prescribed as a form of “chemical restraint” to keep certain= residents docile. However, as use has decreased, new research suggests that it has not overall outcomes for nursing home residents with dementia

Inappropriate use of antipsychotics to keep nursing home residents compliant and sedated has been linked to an increased risk of death, and is widely considered a form of nursing home abuse by federal regulators. As a result there has been substantial effort to reduce use of drugs like Risperdal and Seroquel at facilities nationwide.

However, according to a study published in JAMDA, the Journal of the Post-Acute and Long-term Care Medical Association last month, reductions in the use of antipsychotic drugs among nursing home residents has not reduced death rates, or improve hospitalization outcomes. In addition, it has resulted in residents being prescribed more antidepressants, anxiety, sedatives and mood stabilizing medications.

In the study, researchers from the Brown University of Public Health in Providence, Rhode Island, analyzed data from Medicare claims, focusing on long-term care nursing home residents with Alzheimer’s disease and related dementias in the United States.

The team, led by Dr. Andrew R. Zullo, looked specifically for nursing homes that either decreased or maintained/increased antipsychotic drug use.

The data revealed that death rates, overall hospitalization rates, and hospitalizations for specific causes were similar across all groups. This suggests that reducing the use of antipsychotic medications, such as Risperdal and Latuda, did not lead to improved outcomes, including a reduction in hospitalizations, among nursing home residents.

However, the researchers discovered that nursing home residents who were in the group that received lower amounts of antipsychotic drugs, like Abilify, Haldol or Zyprexa, were given more antidepressant, anxiety, sedative, anticonvulsant, mood stabilizer and anti-dementia medications than the groups that had their doses kept the same or increased their doses.

As such, researchers determined that launching intensive programs focused on reducing antipsychotic use in nursing homes may not be the best use of resources, since it does not reduce residents’ death risk or improve hospitalization outcomes among those with Alzheimer’s disease or dementia.

“These findings suggest the need for better strategies that incorporate safe and effective non-pharmacological or pharmacological alternatives for managing neuropsychiatric symptoms of dementia,” the researchers concluded.

Chemical Restraint Concerns

Although findings like the ones above are questioning reductions in the use of antipsychotics in nursing home settings, a study published by researchers from the U.K. last year linked antipsychotic use among dementia patients to an increased risk of heart failure, stroke and other health risks.

Other studies have shown that the practice of using chemical restraints on nursing home patients with Alzheimer’s disease and dementia worsened during the COVID-19 pandemic.

These circumstances eventually led to the White House calling on the Centers for Medicare & Medicaid Services to investigate the inappropriate practice of nursing home staff using drugs like Abilify to tame residents.