An alarming amount of nursing home patients are medicated with antipsychotic drugs, yet most do not have any type of psychosis. One nursing home in Massachusetts, Farren Care Center, has 71% of their patients on these drugs and they are far from being alone. The question is why are nursing homes using these drugs and what are the repercussions for the patients?
Why antipsychotics are being used
The reason antipsychotic drugs are being used in nursing homes is also the reason they should not be. Sound ridiculous? Unfortunately, it is exactly that. The drugs are being used to supposedly treat dementia, yet the FDA has released two black box warnings that specifically state that these drugs are not to be used for that purpose. A black box warning is the strongest warning issued by the FDA and is printed on the outside packaging of the drugs.
Speculation is that the drugs are not only being used to treat dementia, they are used to manage behavior, especially in understaffed homes. At a hearing in November 2011, the Senate Special Committee On Aging asked witnesses exactly why these drugs were being used in nursing homes and that was one of the answers they received. These drugs have a tranquilizing effect on the patients, which makes them easier to manage.
In a report given to the same Senate committee, it is reported that 88% of all antipsychotic drugs that were prescribed off-label and charged to Medicare were for dementia. Medicare stipulates that it will not pay for drugs that are not being prescribed for medically accepted purposes, which is exactly what is happening with these drugs and dementia. Unfortunately, there is a loophole and the drug companies and nursing homes have obviously found it.
Dangers of antipsychotic drugs in the elderly
There are side effects from these drugs that are especially risky with elderly patients. Since many nursing home patients who are being prescribed these drugs do not have any psychosis, they are being exposed to these side effects without the need for the drug. In 2009, three nursing home managers in California were arrested and tried for the deaths of three of their residents due to the use of antipsychotic drugs.
The dangers associated with these drugs are widespread. Weight gain, cognitive issues, urinary dysfunction and cardiovascular issues are just the tip of the iceberg. If used for their intended purpose, the side effects may justify their usage, but when used primarily for the benefit of the facility, not the patient, it is not.
Hopefully, with increased attention from the FDA, Medicare and other government agencies on this matter, the misuse of these drugs can be curbed. It is time to hold nursing homes accountable for their actions and stop the mistreatment and drugging of their patients.
Resources relating to the off-label use of antipsychotic drugs: