The Use of Antipsychotics
What does this mean for me and my loved one?
This section includes guides and information to help individuals and families further understand why the use of antipsychotic medications to treat a person’s symptoms of dementia is most likely not the safest first choice for care, and includes important information on what you should do to advocate for the best treatment options.
Medications and Dementia: An Overview
Dementia is a general term for a decrease in mental ability (memory and thinking) that interferes with daily life. The most common cause of dementia is Alzheimer’s disease, but there are also other dementias, such as vascular dementia or Lewy Body dementia. Dementia can also occur in Parkinson’s disease or Huntington’s disease or in other medical illnesses.
Common symptoms of dementia are having trouble around:
memory loss such as forgetting new information, dates or events
following a recipe or keeping track of bills
following a conversation or taking part in social activities
being mixed up about people, places or time
changes in mood, behavior or personality
The handout below highlights medications that may be given to patients with dementia once this condition has been diagnosed. These medicines may make a difference in a patient’s quality of life.
Reasons why we sometimes consider using medicines:
We want to prolong the time a person with dementia can live at home or keep symptoms from advancing so fast.
We want to help those with dementia who may have depression or anxiety or other upsetting behavioral symptoms
The Use of Antipsychotics: What is the Issue?
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Antipsychotic medications are potent drugs that may have serious side effects. They are indicated to treat conditions and diagnoses such as schizophrenia. They are not generally used for the treatment of symptoms of dementia.
In the past, the use of antipsychotics to treat people with Alzheimer’s Disease and other dementias was often considered an accepted practice. Now we know that antipsychotic medications that are prescribed inappropriately may be dangerous, especially for the elderly and people with dementia. These medications can have serious, life threatening side effects such as stroke and falls. They may increase the risk of death for elderly residents. There are now national and statewide campaigns to stop their inappropriate use.
These factsheets were designed especially for families and individuals affected by Alzheimer's Disease and other dementia, to help them understand important issues around the use of antipsychotic medications on people with dementia, know what kind of questions to ask and where to go for further help and information.
Fact Sheet: Get the Facts about Antipsychotic Drugs and Dementia Care
Report: Treating disruptive behavior in people with dementia
Why is Ending the Misuse of Antipsychotics Important to Consumers?
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The misuse of antipsychotic medications can harm senior care consumers in many ways. When used inappropriately among senior care residents, antipsychotic medications can:
Place Residents at Increased Risk of Injury, Harm and Death
Antipsychotic drugs, when prescribed for elderly persons with dementia, can have serious medical complications, including loss of independence, over-sedation, confusion, increased respiratory infections, falls, and strokes. Antipsychotics can be deadly; in 2005, the Food and Drug Administration (FDA) issued “Black Box” warnings for antipsychotics stating that individuals diagnosed with dementia are at an increased risk of death from their use and that physicians prescribing antipsychotic medications to elderly patients with dementia should discuss the risk of increased mortality with their patients, patients’ families and caregivers. The FDA has also stated that these medications are not approved for the treatment of dementia-related psychosis, nor is there any medication approved for such a condition.
Be Used as a Chemical Restraint for Residents with Dementia
A chemical restraint is a drug not needed to treat medical symptoms and used because it is more convenient for facility staff or to punish residents. Although the Medicare and Medicaid programs prohibit chemical restraints, antipsychotic medications continue to be used for residents with dementia as a means of behavior control and/or as a substitute for good, individualized care. For this reason, it is important to ensure these medications are being used only when appropriate among residents with proper diagnoses for psychotic disorders.
Worsen Quality of Life and Dignity of Residents with Dementia
Antipsychotics can be so powerful that they sedate residents to the point where they become listless and unresponsive. Residents may be slumped in wheelchairs or unable to get up from bed; they may no longer be able to participate in activities they enjoy or even talk with their loved ones.
Cost All Senior Care Consumers Billions of Dollars
These medications often come with a hefty price tag, so the misuse and overprescribing of antipsychotics in senior care facilities is extremely costly for the Medicare and Medicaid programs as well as for taxpayers. Ending the misuse of these medications among senior living residents would help save health care dollars that could be used to serve beneficiaries. According to the Office of the Inspector General for the Department of Health and Human Services, more than half of atypical antipsychotic medications (a class of antipsychotic medications that work significantly differently from older, previously introduced antipsychotics) paid for in the first half of 2007 by Medicare were incorrectly prescribed and cost the program $116 million during that six-month time period. Ending the misuse of these medications among residents would help save health care dollars that could be used to serve beneficiaries.
Common Antipsychotics Inappropriately Prescribed to Residents
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According to the Office of Inspector General for the Department of Health and Human Services, the three most commonly prescribed antipsychotic medications in 2007 among senior living residents were: Seroquel, Risperdal, and Zyprexa. Other commonly prescribed antipsychotics according to the report included Abilify, Clozaril, Geodon, and Symbyax. Click here to read the report.
National Data on Antipsychotic Use in Nursing Homes
The Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare Website
This resource allows users to research data on individual nursing homes, including the percentage of residents receiving antipsychotic medications under the section entitled 'Quality Measures'. It also lists the state average and the national average of antipsychotic use in comparison to each individual nursing home's data.
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Through the National Partnership to Improve Dementia Care in Nursing Homes, the Centers for Medicare and Medicaid Services is partnering with federal and state agencies, nursing homes, other providers, advocacy groups, and caregivers to improve comprehensive dementia care. CMS and its partners are committed to finding new ways to implement practices that enhance the quality of life for people with dementia, protect them from substandard care and promote goal-directed, person-centered care for every nursing home resident. The Partnership promotes a multidimensional approach that includes public reporting, state-based coalitions, research, training and revised surveyor guidance.
Since the launch of the National Partnership, significant reductions in the prevalence of antipsychotic use in long-stay nursing home residents have been documented. The National Partnership continues to work with state coalitions and nursing homes to reduce that rate even further. Recently, CMS established new national goals for reducing the use of antipsychotic medications in long-stay nursing home residents by 25 percent by the end of 2015, and 30 percent by the end of 2016. These goals build on the progress made to date and express the Partnership’s commitment to continue this important effort.
ProPublica's Nursing Home Inspect Website
This resource allows you to search nursing home inspection reports listing deficiencies cited in nursing homes nationwide. You can search by state, severity of the deficiency and by keyword (i.e. "antipsychotic") to find deficiencies related to the inappropriate use of antipsychotic medications in individual nursing homes.