An Office of the Inspector General report says that nearly nine out of 10 prescriptions for antipsychotics given to Medicare beneficiaries are for unapproved uses. The dangers include an increased risk of death, life-threatening nervous system problems, movement disorders, high blood sugar, diabetes, pneumonia, ulcers, and low blood pressure. Medicare is calling for a 15% reduction in antipsychotic use in nursing homes, though the use of antipsychotics often begins, is maintained, or is increased in hospitals.
From the article:
“In the hospital in my experience, unfortunately it’s the most overused drug… a medical straightjacket,” says Louis Caplan, MD, senior neurologist and expert in neurologic pharmacology at Beth Deaconess Medical Center in Boston.
“Anybody who’s a little hyperactive or agitated—and they’re usually agitated for a medical reason, which is they’re sick, in pain, or have an infection—you give them these drugs and it makes them less responsive. You’re less able to get a history or examine them. And then it wears off, there’s a rebounding of excitation and hyperactivity, so (they’re given) higher and higher doses, and sometimes it takes days or weeks to wear off,” Caplan says.
Rather, Caplan says, “tender loving care” of patients can go a long way to calm them down. “But here the problem is that nurses are now so forced to get on the computer and put all these things in the record, they’re not doing as much bedside nursing, staying with the patient.”
During the 14 years he was chief of neurology at Tufts Medical Center, haloperidol was banned, “and we didn’t have a problem,” he says. Haloperidol was not named in the OIG report, but is another common drug that does not have FDA approval to treat behavioral problems in older adults with dementia.
Readers might reflect on the contrast between the fact of mass antipsychotic drug sedation in nursing homes and the government’s suggestion of a 15% reduction. What does the 15% suggestion tell us? If widespread use of old-fashioned fabric-and-leather straitjackets were the fashion in nursing homes (as was the case within our lifetimes), would a recommendation for a 15% reduction be cause for applause?
Report comment