Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions.

 If you have an elderly loved one living in a nursing home, especially if they suffer from dementia, you may want to double-check their prescription medications. A recent government audit on Medicare spending shows some rather alarming practices in regard to the use of powerful atypical antipsychotic drugs. As The New York Times reports, nearly 1 in 7 nursing home patients, nearly all of them with dementia, are given powerful antipsychotic drugs even though the drugs are not approved for such use and are known to increase the risk of death, especially in patients with dementia.

Ostensibly, the purpose of using antipsychotic drugs is to ensure a quality of life by treating patient agitation. But Daniel R. Levinson, inspector general of the Department of Health and Human Services, noted that such drugs – which include Risperdal, Zyprexa, Seroquel, Ability and Geodon – are “potentially lethal” to many of the patients getting them and that some drug manufacturers illegally marked their medicines for these uses “putting profits before safety.”

Consider the following audit results:

• Of the approved usage claims, 22 percent, or 317,971 of 1.4 million claims, for antipsychotic medicines were found to be either excessive in dosage or duration, against government regulation.
• Of all usage claims, 83 percent of antipsychotic prescriptions for elderly nursing home residents were for uses not approved by federal drug regulators, often for dangerous reasons.
• Of those unapproved usages, 88 percent were to treat patients with dementia, the very same for whom the drugs tend to be the most lethal.

To read more you can consult the audit report, the original article, or the companion blog topic there as well.

Treating patients suffering from dementia is never simple or easy. As the New York Times reported:

While the Food and Drug Administration has warned doctors that using antipsychotic drugs in elderly patients with dementia increases their risks of death, doctors continue the practice because they have few other good choices, said Dr. Daniel J. Carlat, editor in chief of The Carlat Psychiatry Report, a medical education newsletter for psychiatrists. “Doctors want to maximize quality of life by treating the patient’s agitation even if that means the patient will die a bit sooner,” Dr. Carlat said.

No question, this is a difficult issue. Medicare may implement more strict oversight and could potentially deny coverage for some of these prescription claims.

Perhaps one good result would be vigilance on the part of patient families. If your loved one is in a nursing home and being prescribed any of these powerful medications to treat dementia, you may want to start asking questions and even consider getting a second opinion.