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Limiting Antipsychotic Medications in Nursing Homes

In nursing homes across the country, residents receive medical care that sometimes includes treatments and prescriptions for physical and mental infirmities. Sometimes residents will be prescribed antipsychotic medications, which are meant to act against symptoms of psychosis in which the person cannot think clearly, maybe hears voices, or consistently speaks irrationally and illogically. Some of the patients receiving these drugs suffer from dementia, for example. Dementia patients are easily prone to confusion, and can be prone to agitation and even violence. One concern for residents or patients and for their families is the overuse of these drugs to the detriment of the patients. Nursing homes may see these drugs as an easier alternative to calm and control patients–chemical restraints. This may especially be so where the nursing home is understaffed or the staff is not well trained enough to handle agitated and violent patients. While maintaining control in the nursing home is important, these drugs can have adverse effects on this patient, which is not worth their use simply to make things easier on the nursing home and its staff.

In Tennessee, the number of patients receiving antipsychotic drugs in nursing homes is the highest in the nation, according to information from the Centers for Medicare and Medicaid Services (CMS). According to The Tennessean, the use of antipsychotic medications was over 23% in the fourth quarter of 2013, and was fifth highest in the nation behind Illinois, Louisiana, Mississippi and Texas. In 2010, more than 17% of patients nationally received excessive daily doses of antipsychotic medications, according to the CMS report. The article also mentioned that Hawaii, Alaska and Michigan had the lowest rates, and for comparison the national average in the fourth quarter of 2013 was 20.2%. Tennessee has, however, reduced its use by 22% from mid-2011 until recently, and the national rate decreased by approximately 15% according to the article.

Tackling the Chemical Restraint Problem
The federal government conducts research and collects data as part of a campaign to decrease the overuse of drugs by the elderly, including nursing home residents. The CMS has launched a partnership to work on this initiative. It has also disbursed federal money to state health agencies to train nursing home aides in the tempered and more appropriate use of antipsychotic medications. In addition to re-training staff in the use of medications, reforms include the use of alternative treatments that entail therapy and exercise, both mentally and physically. Such efforts appear to being having positive effects, as there has been an overall reduction in use across the country. Approximately 30,000 fewer residents of nursing homes use these medications

Additionally, the Centers for Medicare and Medicaid Services report indicates that the use of antipsychotic drugs is not approved to treat dementia, which affects more than half of all nursing home patients. So not only is there an initiative to reduce the use, but CMS has effectively told nursing homes that it should not be used to treat dementia patients.

While much focus is on long-term care facilities, short-term care facilities have also shown decreases in the use of antipsychotic medications. In general short-term patients are not as likely to be treated with these drugs, but the overall reduction in whatever use there is appears to be encouraging.