This ‘overusing’ continues despite the fact that these medications are only approved for other serious mental illnesses such as schizophrenia. While many nursing home and consumer organizations are pushing for change, the overmedication of nursing home patients continues.
An effort to reduce use
The federal Centers for Medicare and Medicaid Services are actively trying to reduce the use of antipsychotic drugs. The campaign to reduce nursing home use of these antipsychotic drugs started in March 2012 with a goal of reducing the overall use 4 percent (from 24 to 20 percent) by the end of 2012. CMS pushed the goal back to later in 2013 when it initially missed its target. Despite the fact that use of these medications is declining, the agency reports that 21 percent of patients in long-stay nursing facilities still receive these medications. According to the Center for Medicare Advocacy, that would mean more than 300,000 nursing home residents.
Aggressive marketing from pharmaceutical companies
Another part of the problem is the fact that many pharmaceutical companies are aggressively off-label marketing their drugs to nursing homes. Despite the fact that certain medications might treat certain conditions or part of the condition, the FDA may not approve those medications to treat those specific diseases.
A recent settlement by Johnson & Johnson highlights part of the problem with off-label marketing. The company agreed to a $2.2 billion settlement of civil and criminal charges after aggressively off-label marketing certain medications to nursing homes. One of the specific examples was Risperdal, a drug that the FDA did not approve to treat dementia. However, this did not stop the company from promoting it as such, despite the fact that elderly patients had an increased risk of stroke when using this medication.
Medication does play its part
This is not to say that antipsychotics might not be necessary to help patients with dementia. Sometimes these medications are necessary to reduce agitation. However, there is a big difference between almost-routine use of a medication as a preventative measure to make things easier and using a medication when problems arise.
Keep in mind that physicians can prescribe medications for unapproved use. If physicians believe that a certain medication might work, they are free to prescribe it. The same does not go for pharmaceutical companies. Where drug makers such as Johnson & Johnson cross into illegal territory is that they market these off-label medications for those specific purposes.
Medication cannot replace quality care
The truth is that caregivers do not always have an easy job. It may be especially challenging when they work with patients who suffer from the psychological and behavioral symptoms associated with dementia. Oftentimes these behaviors pose significant challenges for the residents themselves and staff members. However, the truth is that just medicating these patients is not the answer. Experts agree that environmental modifications and other non-pharmacologic measures are the best way to deal with these behaviors. While treatments such as aromatherapy, music, and touch have proven to be successful non-drug therapies, these still require staff members to spend more time with the patient.
Unfortunately, dealing with these patients takes a lot of time, patience, and training. It is important that enough staff be available and the staff know how to work with these patients. Unfortunately, there is a push among large investment companies to buy up chains of nursing homes. After purchase, the effort often becomes to save money where possible. In those situations, it is easier to provide medication than to provide genuine care. When profits and ease-of-treatment come before quality care, it negatively affects all parties involved.