Is Antipsychotic Medication Use Increasing Among Elderly Patients?

May 06, 2018

In recent months, more attention has been given to the use of antipsychotic medications in nursing homes and the danger these drugs pose to residents.  Now, an article published in April 2018 in “McKnight’s Long-Term Care News” begs the question of if antipsychotic medication use is increasing among elderly patients outside the nursing home setting.  Use of antipsychotic medications while independent, or while in assisted living, impacts residents but also could impact nursing homes as residents require more assistance.

Is Antipsychotic Medication Use Increasing Among Elderly Patients?

According to AARP’s Public Policy Institute, off-label prescribing of antipsychotic medications is increasing among elderly individuals – particularly among dementia patients in assisted living facilities.  Off-label prescribing means that a doctor has ordered a prescription for medical conditions outside what the U.S.  Food and Drug Administration (FDA) approved the drug for.  The drug may be considered useful or effective in treating off-label conditions, but doctors should be very careful in determining whether off-label use is appropriate.

Off-label antipsychotic medication use among dementia patients – at home and in assisted living facilities – increased around six percent between 2012 and 2015.  That increase accounts for a rise from 12.6 percent in 2012 to 13.4 percent in 2015.  Off-label use was primarily among women, individuals over 75, and individuals living in the Southern United States.

Because research shows that antipsychotic use among individuals outside nursing homes has increased, the AARP Public Policy Institute is advising that efforts to reduce off-label use of these drugs should extend well beyond the nursing home setting.  Many individuals who enter nursing homes are already prescribed these medications, which raises concerns about continued care and safety once residents enter a facility.

Doctors and care providers have specific obligations to ensure that your loved one is safe, and is only prescribed or given medications that are truly needed.   If you are concerned about your elderly loved one and antipsychotic prescribing or administration, contact Brown & Brothers to learn more about your loved one’s legal rights.

Antipsychotic Medication Use and Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) has a program, the National Partnership to Improve Dementia Care, which has worked diligently to reduce antipsychotic medication use in nursing homes.  Between 2011 and 2017, antipsychotic use was decreased by 34 percent.  The agency has set a goal to reduce use by another 15 percent by 2019.

In 2017, the National Center for Assisted Living reported that 56 “member communities” had successfully met a 2015 quality initiative goal of reducing off-label antipsychotic use by 15 percent, or by achieving a usage rate of five percent or less.  This success represents only a small fraction of the total number of nursing homes and facilities, and elderly individuals, that are impacted by antipsychotic medication use.

Why Antipsychotic Medications are Prescribed or Administered Inappropriately

Antipsychotic medications are strictly regulated, but off-label use is making it much more difficult to mitigate the risks.  For many years, antipsychotic medications have been inappropriately administered to nursing home residents as a means of sedating or restraining them.  Some reports suggest that understaffing is one reason why this occurs.  When nursing home staff feels that they cannot adequately control or manage difficult behaviors, they may choose to sedate residents in order to calm them down.  This practice is highly unethical and illegal, and is a violating of the residents’ legal rights.

Within that same sphere, there is also a great deal of concern about doctors prescribing antipsychotics inappropriately, including diagnosing conditions the patient does not have in order to validate a prescription.  Such instances have been linked to partnerships between doctors and nursing homes, as well as unethical practices based on kickbacks or other incentives doctors may receive from drug manufacturers.  In either case, inappropriately prescribing or administering antipsychotics is unsafe, unethical, and should not be tolerated.

Understanding the Risks of Off-Label Medication Use

If you or a loved one has been prescribed a medication for off-label use, it is important that you understand what that means, and what the risks are.  When medications are prescribed for off-label use, that means that the FDA has not determined the safety or effectiveness of the drug for conditions outside those approved.

According to the FDA, off-label use means unapproved use of approved drugs, such as the following:

  • A drug used to treat a condition or disease that it is not FDA approved to treat. For example, a chemotherapy drug used to treat one type of cancer is used to treat a different type of cancer.
  • A drug is prescribed differently than FDA approved guidelines. For example, a drug that is FDA approved as a capsule being prescribed as a liquid, or oral solution.
  • A drug is prescribed at a different dose than what is FDA approved. For example, the FDA approved dose is one tablet per day, but the prescription instructs patients to take two tablets per day.

If your healthcare provider has recommended you take a medication for off-label use, it is important to ask questions and get the facts before taking the medication.  Consider the following questions recommended by the FDA:

  • What has the FDA approved the drug for?
  • Are there other drugs that are FDA approved to treat my condition or disease?
  • What scientific studies support use of this drug for my condition or disease?
  • What is the likelihood that this drug will treat my condition better than an approved drug?
  • What are the benefits and risks associated with taking this drug?
  • Will my health insurance cover this medication for off-label use?
  • Are there any clinical trials available related to this drug and my condition or disease that I could enroll in?

Understanding Your Legal Rights

Any time you have questions about the medications you are prescribed, or how medications are administered in a nursing home setting, it is important that you understand your legal rights.  As a patient or nursing home resident, you have certain rights that should never been violated by inappropriate medication prescribing or administration.  To learn more about your rights and how to protect yourself or your loved ones, contact Brown & Brothers for a free case consultation.  Fill out our online form to get started.

Sources:

https://www.mcknights.com/news/aarps-elizabeth-carter-efforts-to-reduce-off-label-use-need-to-be-expanded/article/760609/

https://www.fda.gov/ForPatients/Other/OffLabel/ucm20041767.htm