Seroquel is also associated with an increased risk of diabetes, something that I would think a health care professional would be very concerned about for the elderly.

If we think about it, many of these patients are admitted to long term care facilities because they can no longer be managed at home because of safety concerns often related to behaviors that harm themselves or others. Most families try everything before they transfer their loved ones into the care of others. These patients are placed into homes with low paid, undereducated staff who may have 6-8 other similar type patients to bathe,dress,and walk for on their shift. If a patient is confused, agitated, and battling staff, then it takes double the amount of time to provide needed medical and daily care. Antipsychotics and other sedating medications are NOT in the best interest of these poor patients; however no one is willing to pay for what this article rightly suggests is a much better way. But our society and families must be willing to pay for the time and resources that allows for more creative, personalized care by educated professionals and the patients's families.

There are lies, there are damn lies, and then there are statistics! The authors of this article cite "statistical evidence" that "rampant misuse of antipsychotics" is endangering the lives of seniors who reside in Massachusetts nursing homes, and then go on to use some highly misleading and equivocal statistics to prop up their argument. They offer no footnotes regarding the statistical significance of the results. For example, a table and bar graph to show that Massachusetts is not doing as well as the rest of the nation shows median differences of 3 tenths of one percentage point on one common measure, and three percentage points on another measure as though these illustrate something to take seriously. They don't. They are essentially statistical equivalents that do nothing to further their argument. Using an anectdote of a patient who was supposedly "overmedicated" makes a nice human interest story, but ignores the facts: patients with dementias who initially enter nursing homes are at increased risk of falls, agitation, etc, irrespective of what meds they are on,. Very often it takes an adjustment period for a patient with dementia to settle into their new surroundings. Yanking the person from one good home to go to another good home only adds to the person's stress, and deterioration. Far better to work with the staff to collaborate on optimizing the patient's care. As a former nurse practitioner who provided consultation(not employed by any of those nursing home) on palliative care on Boston's north shore, I was in a position to evaluate some of the quality of care parameters of a wide variety of facilities, and your implication that Ledgewood was doing a lousy job based on this flimsy evidence is pretty outrageous. Many things factor into the rate of antipsychotic use in nursing homes. For example, in a nursing home such as Beverly's Ledgewood that has a well regarded Alzheimer's unit, they would tend to attract families who have had trouble keeping an agitated family member in a less secure nursing home. There are a number of private nursing homes that will not accept aggressive, agitated patients, screening them out, so that their "statistics" look nice, and the intensive care these patients require won't increase their labor costs. These variables will invariably impact the parameters your "investigative team" was finding so salient. Off label use of antipsychotic meds can help to reduce the horrible suffering of agitation, sleeplessness, hallucinations that many dementia patients endure. If a family member is concerned that they are being overutilized, they should consult with a phsician specialist: a geri-psychiatrist and have the patient evaluated by a professional who can make recommendations about appropriate dosing.

I cannot begin to be able to describe how frightening it is to watch your mother and father go through their final year or so. Medication is not my "business" and trying to stay on top of the side affects you THINK you see in your parent is just about an impossible task. Arguing with the medical staff, calling the doctors, visiting at odd hours to check up AND being lucky enough to have an RN in the family to turn to (often in tears) is how it all transpired for 3 years. My mother would cry because she hated to see us worrying after her. I now fear the same fate for my children.

What an informative, important, and horrifying article. Thanks to the authors for tackling this complex issue. There is a terrible emotional cost that nursing home patients unable to make their own decisions are paying. And there is also a literal cost: An elderly relative was on seroquel while dealing with dementia and in a nursing home. I happened to see an article in Consumer Reports which compared prices of Seroquel and its generic equivalents. We called the consulting psychiatrist who traveled from one nursing home to another in MA. He had no idea how much Seroquel cost. How could he be clueless when he was prescibing it to his patients? As it happens, my relative was still paying out of pocket and Seroquel is much, much more expensive than a generic equivalent. He asked me to send him the article, which I did! We have to be our own advocates, about side effects and the cost of meds. Did my relative need the Seroquel in the first place? The dosage she took was enormous. I don't know. She certainly was depressed and agitated. Who wouldn't be with Alzheimer's disease?