Click on the links below to find more information on the topic of the misuse of antipsychotic medications.
Residents of long-term care facilities are increasingly being placed on antipsychotic medications despite having no proper diagnosis to warrant their use.Twenty-six percent (26%) of all nursing home residents are given antipsychotic medications. Use is even higher (nearly 40%) among residents with dementia - the very individuals that the Food and Drug Administration (FDA) warns are at serious risk of medical complications and death from taking antipsychotics. In addition, far too often the dangers of these medications are not even discussed with residents and their families and are administered without consent.
The misuse of antipsychotic medications in nursing homes can harm long-term care consumers in many ways. When used inappropriately among nursing home residents, antipsychotic medications can:
Place Nursing Home Residents at Increased Risk of Injury, Harm and Death: Antipsychotic drugs, when prescribed for elderly persons with dementia, can have serious medical complications, including loss of independence, over-sedation, confusion, increased respiratory infections, falls, and strokes. In fact, one study found residents taking antipsychotics had more than triple the likelihood of having a stroke compared to residents not taking these medications. Even worse, antipsychotics can be deadly; in 2005, the Food and Drug Administration (FDA) issued “Black Box” warnings for antipsychotics stating that individuals diagnosed with dementia are at an increased risk of death from their use and that physicians prescribing antipsychotic medications to elderly patients with dementia should discuss the risk of increased mortality with their patients, patients’ families and caregivers. The FDA has also stated that these medications are not approved for the treatment of dementia-related psychosis, nor is there any medication approved for such a condition.
Be Employed as a Chemical Restraint for Nursing Home Residents: A chemical restraint is a drug not needed to treat medical symptoms and used because it is more convenient for facility staff or to punish residents. Although the Medicare and Medicaid programs prohibit chemical restraints, antipsychotic medications continue to be used for residents with dementia as a means of behavior control and/or as a substitute for good, individualized care. For this reason, it is important to ensure these medications are being used only when appropriate among residents with proper diagnoses for psychotic disorders.
Destroy the Quality of Life and Dignity of Nursing Home Residents: Antipsychotics can be so powerful that they sedate residents to the point where they become listless and unresponsive. Residents may be slumped in wheelchairs or unable to get up from bed; they may no longer be able to participate in activities they enjoy or even talk with their loved ones.
Cost All Long-Term Care Consumers Billions of Dollars: These medications often come with a hefty price tag, so the misuse and overprescribing of antipsychotics in long-term care facilities is extremely costly for the Medicare and Medicaid programs as well as for taxpayers. Ending the misuse of these medications among nursing home residents would help save precious health care dollars that could be used to serve beneficiaries. According to the Office of the Inspector General for the Department of Health and Human Services, more than half of atypical antipsychotic medications (a class of antipsychotic medications that work significantly differently from older, previously introduced antipsychotics) paid for in the first half of 2007 by Medicare were incorrectly prescribed and cost the program $116 million during that six-month time period. Ending the misuse of these medications among nursing home residents would help save precious health care dollars that could be used to serve beneficiaries.
The National Long-Term Care Ombudsman Resource Center has developed a toolkit in part through a grant from AoA on the misuse of antipsychotic medications among nursing home residents. This toolkit contains take-away resources for consumers, family members and advocates describing how to recognize symptoms of the improper use of antipsychotics; the rights of residents under federal nursing home laws and regulations; and what consumers, family members and advocates can do to combat this problem. The contents of the toolkit include the following:
In September 2012, the National Ombudsman Resource Center hosted a webinar entitled "Ending Misuse of Anti-Psychotics in Long-Term Care." This webinar included a discussion of the dangers and signs of inappropriate psychotropic drug use, successful alternative person-centered treatments and therapies, resources for more information and current national and state-level efforts to reduce inappropriate medications. Expert speakers included Mary Evans, a Geriatrician/Medical Director; Morris Kaplan, a Nursing Home Administrator; and Claire Curry, a Consumer Advocate. The speaker presentations (in PowerPoint and PDF form) can be accessed below:
According to the Office of Inspector General for the Department of Health and Human Services, the three most commonly prescribed antipsychotic medications in 2007 among nursing home residents were: Seroquel, Risperdal, and Zyprexa. Other commonly prescribed antipsychotics according to the report included Abilify, Clozaril, Geodon, and Symbyax. Click here to read the report.
The Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare Website - This resource allows users to research data on individual nursing homes, including the percentage of residents receiving antipsychotic medications under the section entitled 'Quality Measures'. It also lists the state average and the national average of antipsychotic use in comparison to each individual nursing home's data.
ProPublica's Nursing Home Inspect Website - This resource allows you to search nursing home inspection reports listing deficiencies cited in nursing homes nationwide. You can search by state, severity of the deficiency and by keyword (i.e. "antipsychotic") to find deficiencies related to the inappropriate use of antipsychotic medications in individual nursing homes.
Resources on Legislation and Regulations
Kohl-Grassley-Blumenthal amendment to S. 3187, the Food and Drug Administration Safety and Innovation Act, to require informed consent to administer antipsychotic drugs to elderly persons with dementia
CMS Surveyor Training - This online training on the Use of Antipsychotic Medication by CMS for surveyors, includes two modules, Overview of Antipsychotic Medication Use in Nursing Homes, and Surveying for Antipsychotic Medication Use in Nursing Homes. A third module, Severity & Scope Guidance: Antipsychotic Medication Use in Nursing Homes is in development.
News and Media Resources
Educational Brochure on Improper Diagnosis in a Nursing Home
Developed as part of the statewide effort to reduce the inappropriate use of antipsychotic drugs. Texas has tracked a number of data points related to the issue and are seeing an uptick of new schizophrenia diagnoses. Ombudsmen can distribute this information to residents, councils, family members, and facility administrators.
Information About Inappropriate Drug Use for Long-Term Care Consumers
The Misuse of Antipsychotics in Long-Term Care Facilities
Nursing Home Compare
(Washington State) For you the Resident: Know your Legal Rights about Medications (English, Spanish, Chinese, Somali, Ukrainian, Vietnamese)
(Washington State) Very Important Things to Know about Dementia that touch Your Well-Being
(Washington State) Dementia and Antipsychotics Fact Sheet
(Washington State) Reduce the Misuse
(Texas) Educational Brochure on Improper Diagnosis in Nursing Homes
(California) Toxic Medicine: What You Should Know to Fight the Misuse of Psychoactive Drugs in California Nursing Homes
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