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Antipsychotic Drugs Overused in Nursing Homes

elderly patient with medication and a glass of water

“The government and the industry are obscuring the true rate of antipsychotic drug use on vulnerable residents,” according to investigative reporters with the New York Times (Sept. 11, 2021).

The article states that the incidence of schizophrenia diagnosis in nursing homes has jumped 70% since 2012. They suggest this trend began after public federal systems began reporting antipsychotic use. By adding the diagnosis to a resident’s record, a nursing home can place a patient on an antipsychotic while evading the reporting mandate, they explain.

One in nine nursing home residents has a diagnosis of schizophrenia, according to the reporters. This is a red flag because schizophrenia is generally diagnosed before age 40. And in the general population, it affects about 1 in 150 people.

The schizophrenia diagnosis is one pathway used towards delivering antipsychotic drugs to residents. Antipsychotics given for Tourette’s syndrome and Huntington’s disease are also excluded from the reporting system.

Risks of antipsychotic overuse

Antipsychotic drugs “are dangerous for people with dementia,” according to the article, “nearly doubling their chance of death from heart problems, infections, falls and other ailments.”

Depakote has become another drug of choice in nursing homes, reports the article. Unlike the antipsychotic Haldol, it is an anti-seizure drug. It also makes patients feel drowsy and increases the risk of falls. Its use has risen, say the reporters, and may even have been promoted to nursing homes as a drug that would “fly under the radar.”

21% of nursing home residents on antipsychotics

The reporters found that 21% of nursing home residents are prescribed antipsychotic medications. One reason, the authors conclude, is that “caring for dementia patients is time- and labor-intensive. Workers need to be trained to handle challenging behaviors like wandering and aggression.”

However, they point out that nursing homes face ongoing challenges with understaffing. They note, “Studies have found that the worse a home’s staffing situation, the greater its use of antipsychotic drugs.”

Behavioral problems in nursing homes

In fact, behavioral challenges are extremely common in the nursing home environment and patient caregiving can be a dangerous job, as explained in Behavioral Training for Dementia Care Staff. At GuideStar Eldercare, we work to equip and empower nursing home caregivers through targeted in-service training and clinical support. Often, deeper understanding and training in communication and de-escalation techniques can help reduce aggressive behaviors. (Learn more about managing aggressive behaviors in Alzheimer’s residents.)

Gradual dose reduction and reducing polypharmacy in dementia care are urgent goals for the nursing home industry. Each patient’s clinical situation is unique, and conducting a comprehensive neuropsychiatric assessment is crucial to understanding challenging behaviors. The correct diagnosis and specialized clinical leadership can help to improve the picture through holistic means. In addition, dose adjustments require very careful planning and monitoring. Trained nurse practitioners can assist with this process.

A sharp focus on reducing polypharmacy is fundamental to the mission at GuideStar Eldercare: to enhance the quality of life for our shared patients by easing their suffering while actively promoting their safety, functionality, and dignity. If your facility is struggling with challenging behaviors, please reach out. Our experts are here to help.

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