Plan To Reduce Overuse of Antipsychotics in Nursing Homes

May 31, 2012 — A new plan aims to reduce the overuse of antipsychotic medications in nursing homes by 15% by the end of the year. The initiative is being led by the U.S. Centers for Medicare and Medicaid Service (CMS), in response to a study which found that in 2010, at least 17% of nursing home residents were given unsafe dosages of antipsychotic drugs higher than what is recommended per day.

Antipsychotic drugs are often given to elderly patients with advanced dementia, who often are unable to communicate their own needs. The drugs have a sedative effect and can be used to make aggressive dementia patients easier to manage.

The problem is, antipsychotic medications can increase the risk of death among dementia patients. Despite the risk, the use of these drugs in nursing homes has risen dramatically in recent years. The drugs already carry a Black Box warning about the risk of death, which is the strongest warning that the U.S. Food and Drug Administration (FDA) can place on a drug label.

Another issue is that the Medicare and Medicaid system, funded by the taxpayer, is paying for much of the over-prescription of antipsychotics to vulnerable nursing home residents. People can live for many years with dementia. There may be hundreds of thousands of long-term care residents who are receiving unsafe dosages of antipsychotics, costing hundreds of millions of dollars per year.

In an attempt to fix the problem, the CMS initiative has outlined several goals for improving treatment:

• Provide training to nursing home staff that increases awareness about over-prescription of antipsychotic drugs, while emphasizing the need for high-quality care of patients.
• Advocate alternative ways to sedate dementia patients without heavy doses of antipsychotics, such as planned activities, exercise, outdoor time, and pain management.
• Use an electronic database to compile data on antipsychotic use, and make it publicly available on the website Nursing Home Compare

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