Nursing Homes Misuse Antipsychotics

We have long written about the dangerous issue surrounding the dosing of medications to the elderly, specifically 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.

Atypical antipsychotics are known to be used off label to control some undesirable reactions in the elderly, such as agitation, aggression, and hallucinations, specifically in patients diagnosed with Alzheimer’s disease and dementia, Consumer Reports pointed out, adding that there are no drugs currently approved by the FDA to manage these behavioral issues. Medications often used off label include <"">Abilify (generic: aripiprazole), <"">Zyprexa (generic: olanzapine), <"">Seroquel (generic: quetiapine), and <"">Risperdal (generic: risperidone). Risks include diabetes, movement disorders that can become permanent, pneumonia, stroke, weigh gain, and sudden cardiac death, said Consumer Reports.

A recent review by the American Society of Health-System Pharmacists (ASHP) reports that inappropriate use of antipsychotics remains high in the nursing home resident community, says Consumer Reports. This, over five years after the U.S. Food and Drug Administration (FDA) issued a warning against using these drugs in nursing home populations due to significant health threats, including death, explained Consumer Reports.

FDA estimates revealed that fatalities in the elderly dementia population, with behavioral problems, and who were treated with antipsychotics, was 4.5 percent greater over a so-called “typical” 10-week controlled trial versus 2.6 percent for the control—or placebo—group, said Consumer Reports. This result prompted the agency to mandate its strongest warnings—the black box—be added to atypical antipsychotic medication labeling in 2005, added Consumer Reports. In 2008, the FDA expanded the warning to include the labeling on typical—older generation—antipsychotics such as chlorpromazine (only available in generic form) and haloperidol (Haldol and generic).

Meanwhile, in a recent study published in the 2010 Archives of Internal Medicine, researchers found that antipsychotics were typically initiated in a patient’s first week at a nursing home, suggesting that behavioral interventions—the first treatment of choice—was not used or was used very infrequently, reported Consumer Reports.

Earlier this year, ABC World News reported that the Kern Valley Nursing Home in California used chemical restraints—drugs—to silence residents, as far back as 2003. In some cases, this practice was fatal. The nursing director there, Gwen Hughes, would chemically restrain complaining or annoying patients with strong anti-psychotic medications, said ABC, with practices so intense that three residents there died.

Jerry Brown, California Attorney General, said that Hughes had a patient medicated for “glaring” at her; another patient was chemically restrained for tossing a milk carton, according to ABC. Brown said, “In a couple cases, elderly people were actually held down, restrained against their will, and given excessive amounts of medicine to keep them quiet,” quoted ABC, which added that patients were seen “drooling, dehydrated, and dangerously thin.” Worse, Hughes was previously terminated from another California facility for over-dosing patients, said ABC.

We also recently wrote that the Chicago Tribune broke with an exposé on how some powerful psychotropic drugs are given to nursing home residents in Illinois without consent and valid psychiatric diagnoses. Some have suffered from a variety of adverse responses that include, said the Tribune, “tremors, dangerous lethargy, and a higher risk of harmful falls or even death.” The Tribune said it found 1,200 violations affecting 2,900 patients since 2001, all involving pychotropics; however, it is believed that the figures are higher given the dearth of regular investigations. According to the Tribune, some sites only inspect once every 15 months, and generally only conduct spot checks.

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