“Off-Label” Use Of Antipsychotic Medications Among Nursing Home Residents

AARP’s latest national scorecard on long-term care — Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People With Physical Disabilities, and Family Caregivers — found that care providers in 49 states had sharply cut back on providing dementia patients with off-label use of antipsychotic medications. Twenty-one percent of such nursing home patients were given such medications in 2013 compared with 16 percent by the end of 2016, a number some health care advocates say is still too high.
The drugs are designed to treat mental illnesses such as schizophrenia and bipolar disorder. But nursing homes continue to provide antipsychotics to dementia patients without those conditions as a kind of chemical restraint to control disruptive or self-harming behavior. Although Medicare and Medicaid programs prohibit the use of chemical restraints, the practice persists.

The antipsychotics carry a black box warning that they are not meant for frail older people or patients with Alzheimer’s disease or dementia. The consequences of misprescribing can be dire.

The Food and Drug Administration (FDA) has found that antipsychotics are without benefit and are especially dangerous — even deadly — for people with dementia, increasing the risk of stroke, falls, diabetes, heart attack and death. Moreover, these drugs can catapult active and engaged people with dementia into listlessness and impede their ability to manage daily activities such as bathing, dressing, eating, ambulating and conversing with others.
Nursing homes are increasingly using alternatives to deal with the challenges dementia can create. Dementia patients who experience agitation from pain or fear, for example, are being treated with reflexology and music and art therapy. Reducing boredom, providing stimulation and giving more personal attention also can often alleviate troublesome behavior.

Still, while legal, regulatory and educational efforts to cut the use of antipsychotic medications in nursing homes are heading in the right direction, the danger is too great to be content with a leisurely pace, experts say.

Reference Antipsychotic Drug Use for Dementia Patients Still Widespread from AARP website: http://www.aarp.org/health/conditions-treatments/info-2017/nursing-homes-antipsychotic-drugs-fd.html