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Excessive Medication Common in Nursing Homes

MedPage Today reported on a national analysis that revealed more than one in five U.S. nursing home residents are given antipsychotic medications.

Becky A. Briesacher, PhD and colleagues from the University of Massachusetts in Worcester conducted a study of more than 1 million patients in nursing homes in the U.S. The study revealed that 22% of the residents were given at least one prescription for an antipsychotic agent. The researchers analyzed data provided by Omnicare, a long-term care pharmacy which provides medication services across the country to many nursing facilities. The researchers found that nursing homes kept sparse records on the dispensation of antipsychotic medications so the most accurate way of measuring the use of antipsychotic medication was by examining Omnicare’s records.

Omnicare’s records contained extensive patient information including age, sex and location of residence for reimbursement purposes. The researchers noted this data was “complete and accurate.”

The article stated that the analysis included 1,402,039 total residents. This included a subset of 561,681 residents who were observed for 3 months. 308,449 residents had been given at least one antipsychotic medication. The analysis indicated that in over two-thirds of the instances of medication, the medication prescribed was from the “atypical class of antipsychotics” which is primarily used for the treatment of schizophrenia and other bipolar disorders.

The three most common medications were Quetiapine (Seroquel), Risperidone (Risperdal) and Olanzapine (Zyprexa).

The researchers noted that in the subgroup of residents who were observed continuously for 90 days the average duration of treatment with the antipsychotic drugs was 70 days. This raises concerns of the extent of the over medication problem in the facilities.

“The most common antipsychotic prescribed are often used for off-label indications related to dementia, and the extended durations of use raise concerns about the care of frail elders residing in (nursing homes),” the researchers explained.

The researchers also found that the results did not coincide with a particular region of the country. “Geographic variation suggests the absence of an evidence-based approach to the use of these medications in (nursing homes),” Briesacher explained. This only strengthens the theory that these antipsychotic medications are not prescribed correctly.

The study by Dr. Briesacher is alarming. The high frequency with which antipsychotic medications are being prescribed in U.S. nursing homes indicates that nursing home administrators or employees are abusing nursing home residents by excessively or unnecessarily medicating the residents. Elder residents who already have weakened immune systems are more susceptible to the side effects of medications. A slight increase in the dosage of a medication can have amplified effects on a resident. The study cited in this article also points out that these medications are being given for prolonged periods of time. This translates into an increasingly weakened system in patients since they are subjected to the medications for longer periods of time than their bodies are accustomed to. A quote from Briesacher in a research letter in a recent issue of the Journal of the American Medical Association is an excellent assessment of the problem.

“The prescribing of antipsychotic medications persists at high levels in U.S. nursing homes despite extensive data demonstrating marginal clinical benefits and serious adverse effects, including death.”

It is important to monitor the medications prescribed to you or a loved one currently residing in a nursing home. Chicago nursing homes may seek to medicate residents for ulterior motives and end up injuring or possibly killing residents from the side effects.

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