Overuse of antipsychotic
As a follow up to yesterday's blog entry, here is another article about the overuse of antipsychotic medications in nursing homes by Business Week. The practice can threaten physical health. Since the U.S. Food and Drug Administration instituted a "black box" warning in 2005, one study found a 19 percent decrease in the prescription of atypical antipsychotics in elderly people with dementia. But the researchers found that in 2008, antipsychotics still represented 9 percent of all prescriptions in this group.
"The [2005] safety warning pertained to an increased risk of death among individuals using these drugs, so the public health ramifications of use of these drugs in elderly people with dementia, often in nursing homes, which we consider a vulnerable population, is concerning," said Dr. E. Ray Dorsey, an assistant professor of neurology at the University of Rochester Medical Center and lead author of one of the studies in the Jan. 11 issue of the Archives of Internal Medicine.
Antipsychotics are widely used "off label" to control difficult behavior in elderly people with dementia. Indeed, Dorsey said he suspects that the vast majority of the use documented in his research is "off label." In the United States, no antipsychotics are approved to calm behavior.
The second study found that almost one-third of residents in nursing homes were prescribed antipsychotics and that one-third of that number did not have dementia or psychosis. Newly arrived residents were more likely to receive this type of drug if they were in a nursing home that routinely prescribed such drugs, suggesting that organizational culture and not patients are driving the trend.
"If you enter a nursing home that has a higher proportion of people on antipsychotics, you are also likely to be put on antipsychotics," Briesacher said.
