A Medicare watchdog is hoping to curb the use of antipsychotic medications in nursing homes, a growing and dangerous issue on which we have long been writing. As we’ve said, 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.
The Centers for Medicare and Medicaid Services (CMS) say they plan on minimizing the use of these powerful drugs in nursing home residents by 15% by year-end, said MedPageToday. The plan, announced by CMS Acting Administrator Marilyn Tavenner, is a collaborative effort involving federal and state governments, nursing homes, healthcare providers, advocacy groups, and caregivers.
Antipsychotics, which include drugs like Clozaril (clozapine), Abilify (aripiprazole), Seroquel (quetiapine), Zyprexa (olanzapine), and Risperdal (risperidone), are not approved for the treatment of dementia, but are being used, off-label, in nursing homes to treat a host of unapproved diagnoses, including dementia, said MedPageToday. There are no drugs currently approved by the U.S. Food & Drug Administration (FDA) to manage agitation, aggression, and hallucinations in the elderly and those diagnosed with Alzheimer’s disease and dementia. Risks include diabetes, movement disorders that can become permanent, pneumonia, stroke, weight gain, and sudden cardiac death.
A 2011 Department of Health and Human Services Office of the Inspector General (OIG) report revealed that about 14% of all nursing home residents with Medicare had claims for antipsychotics; 88% of the atypical antipsychotics prescribed off-label were for dementia.
According to the CMS, the rising practice of unnecessarily treating the elderly with antipsychotics represents a significant change in how dementia care is handled, wrote MedPageToday. The CMS press release also stated that in 2010, over 17% of all nursing home patients received daily doses of antipsychotics and at greater than the recommended dosage. Worse, “A CMS nursing home resident report found that almost 40% of nursing home patients with signs of dementia were receiving antipsychotic drugs at some point in 2010, even though there was no diagnosis of psychosis,” said CMS Chief Medical Officer and Director of Clinical Standards and Quality Patrick Conway, MD, according to MedPageToday.
The initiative, entitled, the “Partnership to Improve Dementia Care” includes launching a new nursing home staff training program focused on high quality care and abuse prevention; ensuring data on antipsychotic use in nursing homes is available on Nursing Home Compare, effective July 2012; emphasizing nonpharmacological alternatives over antipsychotics for nursing home residents such as consistent staff assignments, increased exercise and outdoor time, acute and chronic pain oversight and management, and planning individualized activities.
Conway pointed out that, “Managing dementia without relying on medication can help improve the quality of life for these residents,” wrote MedPageToday.
Senators Charles Grassley (Republican-Iowa) and Herb Kohl (Democrat-Wisconsin) requested the report and have long been urging the CMS to look at antipsychotic use in nursing homes, said MedPageToday.
The FDA states that antipsychotics can lead to dizziness, sudden blood pressure drops, abnormal heart rhythm, blurred vision, and urinary problems in dementia patients. Yet, prior reports 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. In fact, 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 were suffering from Alzheimer’s disease or some other dementia-related disorder despite that antipsychotics are intended for people diagnosed with schizophrenia.