Pressure Mounts to Reduce Use of Antipsychotics in Dementia Patients

Antipsychotic medications are typically used to treat patients with schizophrenia or bipolar disorder, helping reduce and control delusional thinking and hallucinations. In nursing homes around the United States, staff also use antipsychotics for patients suffering from dementia as a way of controlling paranoia and aggression. These medications can be useful for the small percentage of dementia patients who actually demonstrate psychotic behavior and constitute a risk to other nursing home residents and themselves. For most dementia patients, antipsychotics may only further isolate them and make them even less communicative. This is of particular concern to families and loved ones of dementia patients, who wish to ensure that they are receiving the best possible care.

An FDA warning from 2005 gives notice to doctors of an increased risk of death from pneumonia or heart attacks among dementia patients prescribed atypical antipsychotics. This class of drug includes Abilify, Geodon, Invega, Risperdal, Seroquel, and Zyprexa. The agency added the older class of drugs known as typical antipsychotics to that warning in 2008. Typical antipsychotics include drugs like Thorazine and Haldol. Despite the warnings, off-label use of antipsychotic medications in dementia patients continues.

The Associated Press reports that nursing homes are beginning to take notice of the risks inherent in using antipsychotics for dementia and are gradually decreasing their rate of use. One nursing home in Florida has seen a reduction in the rate from twenty-five percent of all patients to a current rate of fourteen percent. A Brooklyn, New York nursing home went from thirty to fifteen percent without much trouble. Most patients taken off the antipsychotic regimen reportedly displayed significant improvements in both mood and behavior.

Among nursing home staff, the concern is that, without the antipsychotic medications, they will be unable to control aggressive or violent dementia patients. Some patients may truly need such medication, especially since there are no FDA-approved drugs specifically treating behavioral aspects of dementia. Patient advocates cited by the Associated Press argue that the use of such medications has more to do with keeping patients sedated for staff convenience. In situations where use of antipsychotics may be endangering a patient’s life, all other concerns should be secondary to protecting the patient.

Although a consensus may be developing that antipsychotic medications are not worth the risk in all but the most extreme cases, many nursing homes have not caught up to this feeling. The AP reports that spending by nursing home on antipsychotics through Medicare dropped from $7.9 billion in 2006 to $3.7 billion in 2008. That is a significant drop, but it is also still a large amount of medication. An increased use of generic drugs and the start of Medicare’s prescription drug program may account for some of that drop, rather than an actual decrease in use.

The Maryland nursing home lawyers at Lebowitz and Mzhen assist people who have been injured due to improper medications. If a loved one has suffered harm because of an incorrect prescription for dementia, contact the firm today for a free and confidential consultation.

Web Resources:

Public Health Advisory: Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances, Food and Drug Administration, April 11, 2005
FDA Requests Boxed Warnings on Older Class of Antipsychotic Drugs, Food and Drug Adminstration, June 16, 2008
Atypical Antipsychotics Use for Dementia Drops After FDA Warning, PsychCentral, February 7, 2011
Use of Atypical Antipsychotics in Treatment of Dementia Declined After FDA Warning, Science Daily, February 8, 2011

More Blog Posts:

Psychiatric Report Says U.S. Needs to Prepare for Increase of Elderly Dementia, Maryland Nursing Home Lawyer Blog, June 8, 2011
Dementia Patient’s Wandering Leads to Death—Nursing Home Fined $20K for Negligence, Maryland Nursing Home Lawyer Blog, June 6, 2011
Resident Assault Leads to Wrongful Death Lawsuit, Maryland Nursing Home Lawyer Blog, July 27, 2010

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