Recently the National Consumer Voice for Quality Long-Term Care created a fact sheet that provides a helpful overview of a very acute problem in senior care: the overuse of antipsychotic medications. The problem is particularly troubling when used to control senior’s with cognitive conditions like dementia. The overuse is an example of nursing homes choosing the easy road without promoting the health and well-being of each individual senior resident in their care.
As outlined in the fact sheet, many nursing home residents receive these drugs without a proper diagnosis for one of the specific conditions that the drugs are supposed to treat. This means that they are given out far too leniently. The sheet suggests that a staggering one-quarter of all nursing home residents are on antipsychotic medications. When just residents with dementia are considered the number jumps even higher. Amazingly, almost 40% of nursing home residents with dementia are taking antipschotics. And this all is true even though the U.S. Food and Drug Administration has issed a “Black Box” warning on use of the drug for these residents leads to increase risk of serious complications, including even death.
That is not to say that there are no circumstances when these drugs might be appropriate. But the current use-level suggest a very serious problem where the medication is a one-size-fits-all approach to a problem that demands individual attention and care.
The harm caused by this overuse is real. For example, one study found that those taking antipsychotics were 300% more likely to suffer a stroke. That is on top of the incresed risk of death which prompted the FDA warning. Also, the medication itself often causes over-sedation, confusion, and isolation. Seniors are more prone to falls and other preventable accidents at those times. Their ability to interact with the world around them, including friends and family, is also often diminished.
Obviously there are side-effects to many medical treatments. But those side effects, particuarly when they are as serious as here, have to be balanced against honest assessments of the real need for the drug. If there are other alternatives that avoid these harms, then they need to be fully explored. Right now, most caregivers rarely take advantage of those alternatives.
The Consumer Voice fact sheet provides more information about alternatives that need to be fully explored by caregivers. Most notably, individual attention must be paid to understand why the particular resident might be displaying behavioral problems. Anger, worry, fear, agitation, and other issues are symptoms of something else, and labeling them all “problem behaviors” that require medication is insufficient. It may be easier for the caregiver to blunt all of these problem behaviors with medication, but it is a great disservice to the resident and their family. Individualized care plans must be created and used at all times to offer real alternatives.
In addition, providing full support services is a key way to best serve residents with cognitive conditions without the need for overuse of antipsychotic medication. Most notably, fully trained and large staff is essential to ensuring that residents can be monitored properly, with individual attention. When a facility is understaffed, there is a tendency to resort to the medication as a way to place residents in a mental state that is easier to control. This is attractive for over-worked front line caregivers. But at the end of the day it is nothing more than a dangerous and unfair way that nursing homes residents with these conditions are not subject to the reasonable care that they deserve.
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National Consumer Voice Public Policy Agenda