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Risky Antipsychotic Drugs Still Overprescribed In Nursing Homes

Antipsychotic drugs, such as haloperidol and risperidone are FDA-approved for treating schizophrenia and bipolar disorder, but can increase the risk of death in older people who have dementia.

A study published Monday by Human Rights Watch finds that about 179,000 nursing home residents are being given antipsychotic drugs, even though they don't have schizophrenia or other serious mental illnesses that those drugs are designed to treat.

Most of these residents have Alzheimer's disease or another form of dementia and antipsychotics aren't approved for that. What's more, antipsychotic drugs come with a "black box warning" from the FDA, stating that they increase the risk of death in older people with dementia.

The study concluded that antipsychotic drugs were often administered without informed consent and for the purpose of making dementia patients easier to handle in understaffed facilities.

Researchers focused on six states, including California and Texas, which have the most skilled nursing facilities. They used publicly available data, along with hundreds of interviews with residents, families and state ombudsmen, the officials who deal with complaints about long term care facilities.

In 2012, the federal government began a program to reduce the use of antipsychotic drugs in nursing homes, in partnership with the nursing home industry, and advocacy organizations. Since then, the use of the drugs has dropped by about a third nationwide, from 23.9 percent of residents in 2012 to 15.7 percent at the beginning of 2017. The Centers for Medicare and Medicaid Services have called for an additional 15 percent reduction by 2019 for those nursing homes that have lagged in curtailing their use of antipsychotics.

But the Human Rights Watch study contends that the federal government hasn't done nearly enough. It faults the government for failing to enforce laws that exist to protect nursing home residents from what are sometimes called "chemical restraints."

An NPR investigation into the first few years of the government's program to reduce the use of antipsychotic drugs found that only 2 percent of cases were deemed serious enough to trigger a fine.

The study also calls for the government to strengthen informed consent procedures and to establish minimum staffing levels, something that has long been opposed by the nursing home industry.

The American Health Care Association, which represents most nursing homes, said in a statement that the report "does little to highlight the effort launched by our profession in 2012 that has resulted in a dramatic decline in the use of these medications."

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