Nursing Home Efforts to Reduce Antipsychotic Drugs Fall Short

nursing_home_antipsychotic_reductionA two-year effort by the federal government and the nursing-home industry has reduced the use of powerful antipsychotic drugs like Risperdal, Seroquel, Zyprexa or Abilify among elderly nursing-home residents, but U.S. officials say the decline fell short of the program’s goal.

The Wall Street Journal reports that the percentage of patients receiving antipsychotics fell to 21.7 percent in the first quarter of 2013 from an average of 23.9 percent in the last quarter of 2011. This represents a 9 percent decrease, according to data the Centers for Medicare and Medicaid Services (CMS) is expected to release soon. CMS had hoped to achieve a 15 percent reduction in the rate of antipsychotic use by the end of 2012.

The reduction effort was undertaken because of fears that antipsychotic drugs are being overused, especially on the elderly with dementia or Alzheimer’s disease, according to the WSJ. These drugs increase the risk of death to these patients and are costly to the Medicare program, which reportedly spent $7.6 billion on antipsychotics in 2011, according to CMS.

Critics of the widespread use of antipsychotic drugs said government needs tougher oversight of these drugs, according to the WSJ. The U.S. Food and Drug Administration (FDA) imposed its strongest warning label – a “black box” – in 2005 on all atypicals (the newer class of antipsychotics) saying that elderly patients with dementia face an increased risk of death from the drugs. Stephen Crystal, a health researcher at Rutgers University, said, “These drugs are estimated to increase risk of death by 60% to 70% in elderly patients with dementia, based on results of 17 randomized clinical trials enrolling more than 5,000 patients.”

Some nursing-home officials blame the rise in antipsychotic drug use on inadequate staffing. Short-staffed facilities often use sedating drugs to calm agitated patients, the Wall Street Journal reports, although the agitation can be the result of causes like pain or hunger, which the patient may have difficulty expressing.


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