Antipsychotics and Dementia Care – Fighting the Use by Nursing Homes to Over-Medicate Residents for the Convenience of Staff

One common fear of living in a nursing home is the fear of being over-drugged by staff into such a state that we are no longer ourselves.  This situation is sometimes referred to as being “chemically restrained” – a resident is being given drugs so that they can be easier to handle.

In the past, nursing home residents were much more likely to be chemically restrained.  Instead of simply being given medication so that a resident could get through a difficult time – like short-term agitation – medication was often give proactively so that a resident would be highly unlikely to go through the agitative state again.  Such proactive use of medication on an ongoing, daily basis resulted in keeping residents in a fog-like condition.

Using drugs for the purpose making a resident easier to care for by dampening emotions and awareness clearly has significant ethical issues.  As a result, Federal Law was enacted to prohibit the use of medicating residents solely for the convenience of staff.  Under the law, facilities must show that there is a genuine medical reason and need for the drugs to be administered.

With residents suffering from dementia and other conditions, clearly some types of drugs will be beneficial for residents.  Often, physicians have a choice as to which types of drugs to prescribe, as more than one type of drug may be effective.  Different drugs may have different side effects and risks that should be properly evaluated before a choice is made.  In some cases, nursing homes physicians have chosen to prescribe dangerous antipsychotic drugs instead of other drugs because it may make the patients easier to handle, despite the fog-like conditions that often result and the real dangers posed by these drugs.

Off-Label Uses of Antipsychiotic Drugs to Treat Dementia and Other Conditions

Typically, drugs will have been developed to treat certain conditions, such as high blood pressure.  Over time, some drugs may be found to be effective to treat additional conditions, such as depression.  The practice by physicians of prescribing drugs to treat the additional conditions is known as “off-label” prescribing, since the use will be different than the FDA-approved “label” for the drug.

Antipsychotic drugs, such as Risperdal and Seroquel, have been developed to treat bipolar disorder and schizophrenia.  One “off-label” use of these drugs is for use in the treatment of dementia.  However, in such circumstance, the drugs have what is known as a black box warning, the strictest warning by the FDA, which advises of reasonable evidence of a serious hazard.  Black box warnings for these drugs indicate an increased risk of heart failure, infections and death.

The Possible Consequences of Over-Prescribing Antipsychotic Drugs

Antipsychotic drugs can be very effective in treating many types of psychosis.  However, just because they are effective at treating dementia symptoms does not mean that they should be administered for such symptoms, especially when other “safer” drugs are available.  It’s critical that an evaluation be undertaken to determine whether the benefits of such drugs will outweigh the risks, and, especially, whether there are non-antipsychotic drugs that would be more beneficial.

In a NPR news article, USC Professor Bradley Williams stated the antipsychotics should only be used as a last resort, and then only for a month or two before being eliminated.  He went to say that antipsychotic drugs change behaviors.  “They blunt behaviors. They can cause sedation. It increases their risk for falls.” And in the vast majority of cases, the drugs aren’t necessary.

What Family Caretakers and Guardians Need to Know

First, learn the drugs that are being prescribed by your loved one.  Learn why they are being prescribed, their effects when they are taken, and the side effects and dangers that they may pose.

Second, learn if any of the drugs being prescribed are antipsychotics.  If they are, you will want to speak to a doctor or nurse to understand why the drugs are being prescribed, and whether there any safer alternatives.

Third, understand that physicians and medical staff do not have the same vested interest in your loved one’s affairs as you do.  It may not matter much to them whether your loved one is living in a drug-induced fog; it will matter to you.

Lastly, you must be their voice.  An elderly parent – especially one with cognitive issues and who is already being given drugs – will not have the ability that you do to ask the difficult questions.


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