Could Your Loved One Be Taking Too Many Antipsychotics?

Pick the Right Home to Start

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Nearly half of all individuals on antipsychotics in nursing facilities were admitted with a prescription for these medications already in place. The majority of nursing home admissions come directly from the hospital. Make the connection. While hospitals are “drugging” seniors, long-term care facilities are striving for less antipsychotic use, which further contributes to unwanted readmissions. They are somewhat succeeding, but there is a long way to go.

In this article find out what you can do to spot the use of and also prevent the inappropriate use of antipsychotics on your loved one.

In 2010, 24.3 percent of hospital patients 65-84, and 44.3 percent of hospital patients aged 85+ were discharged to a nursing home after an average stay of 5.5 days in the hospital. Nearly 45 percent of hospitalizations among nursing home residents enrolled in Medicare or Medicaid are avoidable. People with dementia are far more likely to be hospitalized than their peers without impaired brain function. About two-thirds of the hospitalizations that occur in people with dementia are for potentially preventable illnesses.

Nursing homes seems to be making progress if you go by data released by the American Health Care Association (AHCA).

The Association recently announced that its skilled nursing center members have lowered antipsychotic use by nearly 30 percent nationwide.

According to data from CMS, 16.7 percent of residents were receiving an antipsychotic medication in the third quarter of 2015 compared with 23.6 percent in the fourth quarter of 2011 — a 29.2 percent decrease.

In 2014, AHCA and CMS set goals to further decrease the use of antipsychotics in skilled nursing centers by a total of 30 percent by December 2016.

Today, 54.6 percent of AHCA member centers have achieved the initial goal of a 25 percent reduction, while 48.9 percent have achieved the goal of a 30 percent reduction.

Federal law prohibits the use of antipsychotics for the convenience of staff. There is even a name for it - "chemical restraint." There has to be a documented medical reason for use.

Consumer Advice

Here are some things to consider when advocating for a loved one.

  • Look for sudden changes in behaviors of a loved one. Are they acting irrational, erratic? Have they become withdrawn? These could be signs they have been medicated.
  • Is a loved one oversleeping? Are they lethargic?
  • Have they become more confused? Has their cognition gone down?
  • Are there any physical symptoms that might indicate medication mismanagement? The introduction of antipsychotics could wreak havoc depending on the other drugs a loved one is taking.
  • Get informed consent from the assisted living, nursing home, hospital or other entity. Completely understand why this is being done.
  • If you haven’t already, have an Advanced Directive in place for a loved one and if appropriate have them designate you as having Medical Power of Attorney.
  • Understand who is overseeing the staff on the floor that is responsible for administering drugs. And scrutinize staff. Often they simply don’t have the training. Other times, it is just convenient to dose a patient.
  • Staffing shortages may often be the reason for careless behavior so when “shopping” for a place make sure to quiz management on staffing ratios and the number of RNs per resident. Take a nurse with you if needed.
  • Ask to see a log of the drugs given to your loved one.
  • Visit the nursing home when medication is typically given.
  • If needed, obtain the assistance of a patient advocate, geriatric care manager, a medical professional and yes, even an attorney.  
  • If push comes to shove, talk to the long term care ombudsman and file a complaint with the state agency that regulates the facility.

Black Box

A black box warning means that the drug carries a major risk of serious or even life-threatening effects.

It is the strongest warning a drug can carry. They take their name from the black border around the drug label or patient information.

Here are the antipsychotic drugs that must have them.

  • Risperdal (Risperidone)
  • Zyprexa (Olanzapine)
  • Seroquel (Quetiapine Fumarate)
  • Geodon (Ziprasidone Hydrochloride, Ziprasidone Mesylate)
  • Abilify (Aripiprazole)
  • Invega (Paliperidone, Paliperidone Palmitate)
  • Haldol (Haloperidol Decanoate, Haloperidol Lactate, Haloperidol)
  • Moban (Molindone Hydrochloride)
  • Navane (Thithixene)
  • Symbyax (Fluoxetine Hydrochloride, Olanzapine)
  • Clozaril (Clozapine)
  • Fazaclo (Clozapine)

Buyer Beware

Johnson & Johnson and its subsidiaries were fined more than $2.2 billion to resolve charges because of their aggressive marketing of drugs, including antipsychotics, to nursing homes. They allegedly paid kickbacks to physicians, as well as to Omnicare, the nation's largest long-term-care pharmacy provider. Eli Lilly did something similar with Zyprexa, marketing to older people in nursing homes and assisted living.

As mentioned before, to really help prevent this from happening, start by first thoroughly researching a nursing home or assisted living for mom and dad. Do your homework. Make an informed choice. Pick a quality home. See our section on Choosing Care to help you. Finding a high quality place is the best way to decrease the odds of antipsychotics being prescribed unnecessarily.  

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