Antipsychotics and Dementia Revisited

November 19, 2013
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In March we posted a blog article which spoke about The Improving Dementia Care Treatment in Older Adults Act, S. 3604. We informed readers that this Bill would require nursing homes to obtain informed consent before an antipsychotic medication is prescribed for a resident with dementia. It also included other important provisions, such as education for prescribers; monthly reports on instances where antipsychotics are administered to nursing home residents with dementia for uses not approved by the FDA; and a study on the appropriate prescribing of antipsychotics for hospital patients. We are now following up about this topic because the Center for Medicare Advocacy recently issued an alert stating that little progress has been made to protect patients with Dementia from wrongfully receiving antipsychotic medication.

This issue resurfaced because of the settlement of charges against Johnson & Johnson for off-label marketing of Risperdal for nursing home residents despite not being approved for this population. The misuse and overuse of antipsychotic medication with dementia patients has been an ongoing problem that was supposed to be addressed in the aforementioned Bill. The issue with Johnson & Johnson led people to look further into the progress that has been made since this Bill was enacted and it seems that virtually none has been made. The CMA cites the following three problems that advocates have found:

1) Recent data from the Centers for Medicare & Medicaid Services (CMS) indicating that nursing facilities have fallen far short of the goal set in July 2012 for reducing the inappropriate use of antipsychotic drugs (The goal set in July 2012 was to be at 20.2% by December of 2012. As of June 30, 2013, the antipsychotic drug rate for long-stay residents was 21.14%.);
2) The Inspector General’s cancellation (as a result of sequestration) of a study of antipsychotic drug use in nursing homes; and
3) CMS’ decision not to require that consultant pharmacists (required by the federal Nursing Home Reform Law) be independent of long-term care pharmacies and
Each of these are discussed in further detail at

Despite the unfortunate lack of progress, there are still ways that people can protect their loved ones from the inappropriate prescription of antipsychotic medication. In our previous blog about this topic we encouraged families to have an on-going dialogue with facility staff and to always feel entitled to know more about their loved one’s treatment. If a Doctor is prescribing an antipsychotic medication, the burden should be placed upon that Doctor to continually assess and monitor the benefits of utilizing these medications. The benefits of these medications should always outweigh the risks. Always report any side effects you notice your loved one experiencing. (Antipsychotics can cause side effects that may include sedation, tremors, increased rigidity and seizures).

Below are some important questions family members can ask the prescribing Doctor:
1. Why is this particular medication being prescribed?
2. How long and how often will the drug be used?
3. How often will the Doctor be monitoring the benefits and risks of such medication usage?
4. How will your loved one’s medical condition be affected?
5. What are the known side effects?
6. What are the reasonable alternative treatments to using an antipsychotic medication?
7. Can the facility suggest any non-medical interventions?
8. What are your loved one’s rights to accept or refuse the medication being prescribed?
9. What are your loved one’s rights to revoke consent for medication for any reason at anytime?

You may also want to utilize our Advocates Checklist

Finally, if you are still uncertain about the benefits of your loved one being prescribed a certain medication, request an independent pharmacological review and always remember your loved one’s rights are to be treated with dignity and respect.

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