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The Boston Globe

Health & wellness

US aims to cut use of drugs on dementia patients

Seeks 15% fewer prescriptions for antipsychotics

Federal regulators announced a multiyear initiative on Wednesday to slash the inappropriate use of antipsychotic drugs on nursing home residents, saying that nearly 40 percent of residents with dementia were receiving the powerful sedatives though they did not have a condition that would warrant it.

The US Centers for Medicare & Medicaid Services said it was aiming to reduce the use of antipsychotic drugs in nursing home residents by 15 percent by the end of this year, through training of nursing home staff and of state inspectors on alternatives to using antipsychotics to quell aggressive and agitated behavior among people with dementia.

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Alice Bonner, director of the agency’s nursing home division, said in an interview that the 15 percent cut is just the first step.

“In 2013 we will set another goal,’’ Bonner said. “At that point, we will be looking at even more significant reductions.’’

Another agency official said during a conference call with reporters that between July and September of 2010, almost 40 percent of nursing home residents with signs of dementia were receiving antipsychotic drugs even though they had not been diagnosed with a psychosis.

The drugs have sometimes-lethal side effects, prompting the US Food and Drug Administration to issue two warnings since 2005 against using them in elderly patients with dementia.

Additional data from Bonner’s agency indicate that more than 17 percent of nursing home residents in 2010 were given daily doses of antipsychotics in excess of recommended levels.

Regulators said nearly 40% of those getting sedatives did not need them.

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Participation in the program to reduce use of antipsychotics is voluntary, but representatives for the two largest nursing home trade groups pledged to work with the government.

“We believe these antipsychotics are overprescribed,’’ said Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, a national trade group. “Many clinicians, physicians, and family members believe these medications are useful and necessary, but data show otherwise.’’

The Globe reported last month that in 21 percent of nursing homes nationwide in 2010, at least one-quarter of residents without illnesses for which antipsychotics are recommended received the medications. In Massachusetts, the proportion was 28 percent of homes.

Based on federal data, the Globe estimated that about 185,000 nursing home residents nationwide received antipsychotics in 2010 contrary to nursing home regulators’ recommendations.

Scott Plumb, senior vice president of Massachusetts Senior Care Association, a trade group that represents most of the state’s 426 nursing homes, said facilities will aim to reduce antipsychotics use by 15 percent by the end of this year.

“Six months is a pretty short time period to do this,’’ he said. “It might be a little aggressive.’’

The Globe’s investigation found gaping disparities in the use of antipsychotics in nursing homes, both in Massachusetts and across the country. Some reported no use of the drugs in residents without a condition that would warrant such medications, and others indicated that 100 percent received the drugs.

“All too often these drugs are prescribed without any explanation to residents or their families about the risks,’’ said Claire Curry, legal director of the civil advocacy program at the Virginia-based Legal Aid Justice Center. The organization is pushing for rules that would require nursing homes to explain the risks before prescribing antipsychotics.

Last week, three US senators filed a proposal that would require federal regulators to issue standardized rules for nursing homes to follow in seeking permission from patients, or their designated health care agents, such as a family member, before administering antipsychotics for so-called off-label use.

The Food and Drug Administration has approved antipsychotic drugs to treat an array of psychiatric conditions, such as schizophrenia, but physicians are allowed to prescribe antipsychotics “off-label’’ for other uses, including aggressive behavior in dementia patients.

Toby Edelman, senior policy attorney at the Center for Medicare Advocacy, said that there are already strong rules against overmedicating nursing home residents but that regulators too often fail to enforce them.

Edelman said she combed through databases nationwide to track how often nursing homes were penalized specifically for overusing antipsychotics during the past six years and could find just a handful of cases.

“Even when instances are cited, nothing happens,’’ Edelman said.

She said she was heartened to hear regulators say on Wednesday that their initiative would also focus on enforcing the overmedication rules.

The agency said it would also post data on each nursing home’s use of antipsychotic drugs on its Nursing Home Compare website in July.

The Globe posted data last month for each nursing home in the United States, obtained through a Freedom of Information Act request, showing the percentage of patients without a psychosis or related condition who nonetheless received antipsychotics.

Kay Lazar can be reached at klazar@globe.com. Follow her on Twitter @GlobeKayLazar.
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