Nursing Homes Overprescribing Antipsychotic Drugs

Nursing homes are overprescribing antipsychotic drugs, according to government figures. The strong, sedating drugs, as we’ve long written, are often used on nursing home patients who are agitated and combative.

A Boston Globe investigation, which involved data collected 19 months after it filed a Freedom of Information Act request with the government, highlighted the dangerous habit that exposes patients to serious side effects, including leaving patients in a stupor, said USA Today. In one case involving Beverly, Massachusetts’ Ledgewood Rehabilitation and Skilled Nursing Center, 19% of residents with no diagnosis involving the need for an antipsychotic, were prescribed the drugs.

The U.S. Food & Drug Administration (FDA) states that antipsychotics can lead to dizziness, sudden blood pressure drops, abnormal heart rhythm, blurred vision, and urinary problems in dementia patients, said the Globe. Yet, the Globe found that more than one in five U.S. nursing homes administered antipsychotics to people with no diagnosis for a condition warranting use of the drugs, USA Today wrote.

The Globe also discovered that, in 2010, some 185,000 U.S. nursing home residents received antipsychotics even though prescribing these drugs went against federal nursing home regulator recommendations. Many of these patients were suffering from Alzheimer’s disease or some other dementia-related disorder. Antipsychotics are intended for people diagnosed with schizophrenia.

“We have an inordinate amount of prescriptions written for a population that is already frail, and we know these drugs increase the risk for side effects, including death,” Michael Gloth, an associate professor at the Johns Hopkins School of Medicine, specializing in seniors, told the Globe. “So why are they being written?”

Those in the nursing home industry who spoke to the Globe, say antipsychotics are often necessary in these vulnerable populations to ensure they do not hurt themselves and others, wrote USA Today. Frank Grosso, vice president of pharmacy services at Genesis Health Care, which owns more than 200 nursing homes, told the Globe that Genesis sometimes prescribes antipsychotics, but at lower doses in patients with psychosis, and that the government data do not reflect use of lower dosing.

As we’ve written, there are dangers in the needless dosing of the elderly with antidepressants, antipsychotics, and sedatives, which are sometimes given for seemingly pointless reasons and, on occasion, appear to be linked to falls and other accidents in the elderly, including death.

A recent FiercePharma report pointed out that about one in seven nursing home residents are treated with atypical antipsychotics, which are not approved by the FDA for dementia treatment and do contain an FDA warning that use of these medications in elderly populations can put this demographic at risk. As a matter-of-fact, over half of all antipsychotic prescriptions paid by Medicare in the first two quarters of 2007 were “erroneous,” said the Health and Human Services Inspector General. Those errors cost the federally funded Medicare, $116 million.

The Center for Medicare and Medicaid Services noted that antipsychotic overuse is due, in part, to drug manufacturers touting the drugs for off-label uses, even paying out physician kickbacks. Prescriptions can be written at physician discretion for off-label uses; however, it is illegal for drug makers to advertise or market medications for uses that are not FDA approved. There are no drugs currently approved by the FDA to manage agitation, aggression, and hallucinations in the elderly and those diagnosed with Alzheimer’s disease and dementia. Medications often used off-label include Abilify (aripiprazole), Zyprexa (olanzapine), Seroquel (quetiapine), and Risperdal (risperidone). Risks include diabetes, movement disorders that can become permanent, pneumonia, stroke, weight gain, and sudden cardiac death.