In the United States, elderly patients with dementia are too often prescribed anti-psychotic drugs to calm their disruptive behavior, a costly and risky practice that should end. Instead, more care should be taken to determine why dementia patients may be acting up and treat those underlying causes, lawmakers were told at a hearing of the Senate Committee on Aging. Daniel Levinson, Health and Human Services Inspector General, testified: “As the Baby Boomer generation ages, it is imperative to address the overuse and misuse of antipsychotic drugs among nursing home patients.”
Recent government audits have raised concerns about the use of antipsychotics by elderly people with dementia in nursing homes, raising their risk of death and wasting money for the US healthcare system. For instance, more than half of such prescriptions were wrongly paid for in 2007 by government Medicare because the patients did not exhibit symptoms of schizophrenia or bipolar disorder, amounting to about $230 million in waste. One audit showed 14 percent of nursing home residents had Medicare claims for antipsychotic drugs.
But another panel member, Toby Edelman, senior policy attorney in the office of the Center for Medicare Advocacy, said that audit’s estimate was low because it only included some kinds of anti-psychotics. Ms. Edelman had this to say about the situation:
Nursing facilities’ self-reported data indicate that in the third quarter of 2010, 26.2 percent of residents had received antipsychotic drugs in the previous seven days. That is approximately 350,000 individuals. Facilities reported they gave antipsychotic drugs to many residents who did not have a psychosis, including 40 percent of patients at high risk because of behavior issues.
Edelman also pointed out that this issue is far from new, and that the same Senate committee had issued a report on the misuse of drugs in nursing homes back in 1975, and held a workshop on the topic two decades ago. The practice persists, even though it is against federal law, because of serious understaffing in nursing facilities, high turnover of staff, and “aggressive off-label marketing of anti-psychotic drugs,” she said.
The pharmaceutical giant Eli Lilly in 2009 paid almost $1.5 billion in a settlement for off-label promotion of its drug Zyprexa as a treatment for dementia. The drug is FDA-approved for bipolar disorder and schizophrenia. According to Tom Hlavacek, executive director at Alzheimer’s Association’s southeastern Wisconsin chapter, elderly people with dementia are sometimes prescribed these potent drugs for behaviors that have other causes.
Urinary tract infections, tooth decay, arthritic pain, or simply moving a patient from one place to another can lead to agitated behaviors. He told lawmakers that their “experience indicates that these care transitions can exacerbate behaviors and often lead to escalating drug treatments.” Experts said solutions could include creating stronger penalties for inappropriate prescribing, and a renewed focus on trying non-pharmacological approaches to a problem first. Jonathan Evans, a doctor who specializes in caring for frail elders, had this to say:
Most doctors treat unwelcome behavior in all settings as a disease that requires medication. These drugs are used as chemical restraints. Behavior is not a disease. Behavior is communication. And in people who have lost the ability to communicate with words, the only way to communicate is through behavior. Good care demands we figure out what they are telling us and help them.
The public should demand that the federal government do a better job of regulating the out-of-control and politically-powerful drug industry. The public would be shocked if it only knew how poorly regulated the drug manufacturers are. The blame really is with Congress and results from the tremendous political power of the drug industry.
Source: New York Daily News
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