A Canadian newspaper’s investigative report reveals an alarming increase in the use of powerful antipsychotic drugs in nursing homes, despite warnings that these medications are dangerous – even lethal – for elderly patients with dementia.
The Toronto Star (thestar.com) found that some long-term care facilities, often short staffed, routinely use these drugs to calm and “restrain” wandering, agitated and sometimes aggressive patients. The Star found that as many as one half of residents at some facilities are on antipsychotics.
Neither the U.S. Food and Drug Administration (FDA) nor Health Canada has approved atypical antipsychotics, including olanzapine (Zyprexa), quetiapine (Seroquel) and others, for elderly patients with dementia. Pharmaceutical companies must place black-box warnings – the strongest – on the drugs’ labels. “Elderly patients with dementia treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo,” the warning reads, and patients taking them face a 60 percent increased risk of death, according to thestar.com.
“Off-label” use of antipsychotics for dementia patients, meaning the drug is being given for a condition or an age group for which it hasn’t been approved is legal. Doctors may prescribe off-label but antipsychotics can cause the very violence and confusion they are supposed to control, the Star reports. While some nursing home residents suffer from conditions for which antipsychotics are approved, the Star reports that 63 percent of those receiving the drugs suffer from dementia. Patients taking these drugs off-label have suffered cardiac failure, strokes, and deadly injuries from falls.
Antipsychotics can be effective in “severe” cases of dementia-related behavior problems, but experts estimate that only 10 to 15 percent of dementia patients have such severe problems, according to the Star. A U.S. government probe of Medicare prescriptions for atypical antipsychotic drugs found the prevalence of these drugs too high and the Inspector General recommended that their use be reduced.
In many instances, behavior issues can be addressed through other means, such as training caregivers to recognize triggers, including hunger and pain, that can result in agitation. But many facilities say they do not have the resources for the training and additional staff needed and so they continue to rely heavily on drugs for “behavioral management,” according to the Star.