Did you know that almost half of all dementia patients living in nursing homes are given antipsychotic drugs?
Off-Label Use Of Antipsychotics
Antipsychotics, which include drugs like Clozaril (clozapine), Abilify (aripiprazole), Seroquel (quetiapine), Zyprexa (olanzapine), and Risperdal (risperidone), are not approved for the treatment of dementia, but are being used, off-label, in nursing homes to treat a host of unapproved diagnoses, including dementia.
There are no drugs currently approved by the U.S. Food & Drug Administration (FDA) to manage agitation, aggression, and hallucinations in the elderly and those diagnosed with Alzheimer’s disease and dementia. Risks include diabetes, movement disorders that can become permanent, pneumonia, stroke, weight gain, and sudden cardiac death.
Government Steps Up
Federal regulators announced a multiyear initiative to slash the inappropriate use of antipsychotic drugs on nursing home residents, saying that nearly 40 percent of residents with dementia were receiving the powerful sedatives though they did not have a condition that would warrant it.
The US Centers for Medicare & Medicaid Services said it was aiming to reduce the use of antipsychotic drugs in nursing home residents by 15 percent by the end of this year, through training of nursing home staff and of state inspectors on alternatives to using antipsychotics to quell aggressive and agitated behavior among people with dementia.
The plan, announced by CMS Acting Administrator Marilyn Tavenner, is a collaborative effort involving federal and state governments, nursing homes, healthcare providers, advocacy groups, and caregivers.
A 2011 Department of Health and Human Services Office of the Inspector General (OIG) report revealed that about 14% of all nursing home residents with Medicare had claims for antipsychotics; 88% of the atypical antipsychotics prescribed off-label were for dementia.
According to the CMS, the rising practice of unnecessarily treating the elderly with antipsychotics represents a significant change in how dementia care is handled. The CMS press release also stated that in 2010, over 17% of all nursing home patients received daily doses of antipsychotics and at greater than the recommended dosage.
The initiative, entitled, the “Partnership to Improve Dementia Care” includes launching a new nursing home staff training program focused on high quality care and abuse prevention; ensuring data on antipsychotic use in nursing homes is available on Nursing Home Compare, effective July 2012; emphasizing nonpharmacological alternatives over antipsychotics for nursing home residents such as consistent staff assignments, increased exercise and outdoor time, acute and chronic pain oversight and management, and planning individualized activities.
Senators Charles Grassley (Republican-Iowa) and Herb Kohl (Democrat-Wisconsin) requested the report and have long been urging the CMS to look at antipsychotic use in nursing homes.