Overuse of Medications in Nursing Homes

In the United States, nursing home residents with dementia are too often prescribed anti-psychotic drugs to calm their disruptive behavior, a costly and risky practice that should end, according to experts. Care should be taken to determine why the resident’s agitation or behavioral issues have increased and treat those underlying causes.

Daniel Levinson, Health and Human Services Inspector General, said recent government audits have raised concerns about the use of antipsychotics by elderly people with dementia in nursing homes, raising their risk of death and wasting money for the US healthcare system.

For instance, more than half of such prescriptions were wrongly paid for in 2007 by government Medicare because the patients did not exhibit symptoms of schizophrenia or bipolar disorder, amounting to about 230 million dollars in waste. One audit showed 14 percent of nursing home residents had Medicare claims for antipsychotic drugs. However, nursing facilities' self-reported data indicate that in the third quarter of 2010, 26.2 percent of residents had received antipsychotic drugs in the previous seven days. Facilities reported they gave antipsychotic drugs to many residents who did not have a psychosis, including 40 percent of patients at high risk because of behavior issues.

The practice persists, even though it is against federal law, because of serious understaffing in nursing facilities, high turnover of staff, and aggressive off-label marketing of anti-psychotic drugs
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Residents are often given these potent drugs for behaviors that have other causes such as urinary tract infections, pressure ulcers, tooth decay, arthritic pain, or simply moving a patient from one place to another can lead to agitated behaviors.

These drugs are used as chemical restraints," said Jonathan Evans, a doctor who specializes in caring for frail elders. "Behavior is not a disease. Behavior is communication. And in people who have lost the ability to communicate with words, the only way to communicate is through behavior," he added. “Good care demands we figure out what they are telling us and help them."

See article at New York Daily News.

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