I read an interesting but tragic story about Gerry Gilgan,a retired New York City firefighter, who was transferred to a nursing home after brain surgery in February 2013, the 78-year-old went had mild dementia, but was in good spirits and lucid when he arrived. Within hours of his arrival, records show Gerry Gilgan began receiving the powerful antipsychotic medications Haldol and Seroquel. Gerry Gilgan’s prescription for Haldol was “as needed,” as frequently as every six hours.
The next day, daughter Patrice Gilgan’s cellphone video shows a different man. Gerry Gilgan’s widow, Marie, was shocked by the sudden change. “We took him into this home thinking this would be the best place for him,” she said. “[After] a day or two, he’s a different person. It was like he was a vegetable. There was nothing to him. Staring in space, drugged out.”
Nursing homes claim the use of antipsychotics is somehow justified, saying they calm agitated, anxious or combative residents. According to the facility, Gerry Gilgan was “combative,” though closed-circuit cameras in the nursing home show no evidence of belligerent behavior.
Patrice Gilgan said her father was never the same after the overdose. Five days after he arrived at Irvine Cottages, Gerry Gilgan fell and was taken to the hospital. He didn’t open his eyes for two and a half weeks, his daughter said. A state investigation later concluded Gerry Gilgan was “overmedicated.”
Antipsychotics are often given to patients for the benefit of the officials at the facility, in order to control them, said Carole Herman, founder of the Foundation Aiding the Elderly in Sacramento. “The patient can’t walk anymore. The patient can’t talk anymore, and so there’s less care because basically the patient is incapacitated,” she said. “They’re zonked out all the time, so you don’t have to be bothered with them.”
Antipsychotic drugs are approved for patients with bipolar disorder or schizophrenia, not for dementia. In fact, the FDA has given its strongest warning – a so-called black box warning – telling physicians not to prescribe antipsychotics to people with dementia because they can cause heart failure, infection and death. Despite the FDA warning, a Government Accountability Office report released this month found one-third of long-term nursing home residents with dementia have received antipsychotics.
Antipsychotics have carried the FDA’s black box warning since 2005. Even so, in 2011, the U.S. Department of Health and Human Services’ inspector general issued a report saying dangerous and “off label” use of the drugs was widespread in nursing homes.
“These powerful and, at times, dangerous drugs are too often prescribed for uses that are not approved by the FDA and do not qualify as medically accepted for Medicare coverage,”Daniel Levinson testified in a Senate committee hearing. “The FDA has imposed a black box warning emphasizing an increased risk of death when used by elderly patients with dementia. Yet 88 percent of the time, antipsychotics were prescribed for elderly patients with dementia.”
Herman of the Foundation Aiding the Elderly said doctors usually prescribe antipsychotics without ever seeing the patient. “The person at the other end of the phone, which is usually the director of nursing or the charge nurse, will call and say, ‘Mrs. Smith is acting out. Prescribe something.’ And they’ll prescribe an antipsychotic because it knocks them out,” Herman said.
In 2013, Johnson and Johnson agreed to pay fines of more than $2.2 billion for marketing the off-label use of the anti-psychotic drug Risperdal and two other drugs. The Justice Department said the company urged doctors and prescribers treating elderly dementia patients to use the antipsychotic for anxiety, agitation, depression, hostility and confusion.
Eli Lilly paid the federal government $1.4 billion in 2009 to settle charges it illegally marketed the antipsychotic Zyprexa. Among the marketing tactics was a “5 at 5” campaign that urged nursing homes to administer five milligrams of Zyprexa at 5 p.m. to induce sleep.
In 2010, AstraZeneca paid a $520 million fine for off-label marketing antipsychotic Seroquel for conditions including Alzheimer’s and dementia, giving doctors illegal kickbacks to serve as authors for articles actually written by the drug company.
Medicare Prescription Drug Plan spent a total of $7.6 billion on antipsychotic drugs in 2011, the most recent figures available, according to CMS.
In nursing homes, Hamilton said lowering antipsychotic use takes more than hiring additional staff. “There’s a body of research that has shown a correlation between lower staffing levels and higher use of antipsychotics,” he said. “But it’s not only the level of the staff, the training of the staff and the leadership.”
Sometimes, it’s a matter of diverting attention. In the memory care unit, each resident has a box with memorabilia – photographs and other small objects that carry a connection to the past. There’s also a crib with two lifelike baby dolls. On one occasion, Cornish said a patient was hallucinating that she could hear a baby crying. A staffer gave the woman a doll.
See article here.