Navigation Links
Antipsychotics Still Widely Used in U.S. Nursing Homes
Date:1/11/2010

Off-label use to control behavior seems to be part of the 'culture' at some centers, one study finds

MONDAY, Jan. 11 (HealthDay News) -- Many Americans in nursing homes still get powerful antipsychotic medications, despite recent attempts by the U.S. government to rein in the practice, two new studies show.

The practice can control problem behaviors, but can also threaten physical health. Since the U.S. Food and Drug Administration instituted a "black box" warning in 2005, one study found a 19 percent decrease in the prescription of atypical antipsychotics in elderly people with dementia. But the researchers found that in 2008, antipsychotics still represented 9 percent of all prescriptions in this group.

"The [2005] safety warning pertained to an increased risk of death among individuals using these drugs, so the public health ramifications of use of these drugs in elderly people with dementia, often in nursing homes, which we consider a vulnerable population, is concerning," said Dr. E. Ray Dorsey, an assistant professor of neurology at the University of Rochester Medical Center and lead author of one of the studies in the Jan. 11 issue of the Archives of Internal Medicine.

Antipsychotics, developed to treat psychiatric conditions such as bipolar disorder and schizophrenia, are widely used "off label" to control difficult behavior in elderly people with dementia.

Indeed, Dorsey said he suspects that the vast majority of the use documented in his research is "off label."

In the United States, no antipsychotics are approved to calm behavior, although one such drug, risperidone (Risperdal), is approved for that indication in Canada. Black box warnings are rare for off-label use.

"There's a real disconnect between the evidence and the prescribing patterns," said Becky A. Briesacher, co-author of the second study, also in the Jan. 11 issue of Archives, and an associate professor of medicine at the University of Massachusetts Medical School in Worcester.

Briesacher's study concluded that seniors who were admitted to nursing homes that already had high rates of prescribing antipsychotics were more likely to get these drugs as well, indicating that an "organizational culture" may be driving the trend.

But according to Dr. Davangere Devanand, director of geriatric psychiatry at the New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons in New York City, there's little else to control aggression and agitation.

"The only medications that have been shown to work are antipsychotics, but the problem is they have side effects so you get into a situation where it may work in some patients but it may cause some significant side effects in some patients. It's a balance," he said.

Dorsey's study looked mainly at atypical antipsychotic drug use -- meaning second-generation drugs. Clozapine, the first atypical antipsychotic, was introduced in the United States in 1989 and later was followed by risperidone, olanzapine and paliperidone, according to background information with the study.

The researchers looked at the number of times the subject of antipsychotics was brought up during doctors' office visits.

Between the beginning of January 2003 and March 2005, these mentions accelerated at a rate of 34 percent per year, 16 percent among elderly patients with dementia.

In the year after the advisory was issued, mention of atypical drugs dropped 2 percent overall and 19 percent among the dementia population. The declines were evident within one month of the warning.

And by 2008, antipsychotic use among this older population decreased more than 50 percent.

It's not clear if that drop was "enough," or if the drugs are still being overprescribed, said Dorsey.

"Whether or not 19 percent is an appropriate decrease or not is uncertain," he said. "We can say that atypical antipsychotics are commonly prescribed, they have no indication for this use and there is limited evidence for their efficacy," he added.

Devanand said "overuse" is difficult to define. "I don't think we have any way to know what overuse is. No one knows what the use should be," he said.

The second study found that almost one-third of residents in nursing homes were prescribed antipsychotics and that one-third of that number did not have dementia or psychosis.

Newly arrived residents were more likely to receive this type of drug if they were in a nursing home that routinely prescribed such drugs, suggesting that organizational culture and not patients are driving the trend.

"If you enter a nursing home that has a higher proportion of people on antipsychotics, you are also likely to be put on antipsychotics," Briesacher said.

More information

The U.S. National Institute of Mental Health has more on mental health medications.



SOURCES: Becky A. Briesacher, Ph.D., associate professor, medicine, University of Massachusetts Medical School, Worcester, Mass.; E. Ray Dorsey, M.D., assistant professor, neurology, University of Rochester Medical Center, Rochester, N.Y.; Davangere Devanand, M.D., director, division of geriatric psychiatry, New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York City; Jan. 11, 2010, Archives of Internal Medicine


'/>"/>
Copyright©2010 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. Antidepressant as Good as Antipsychotics for Dementia
2. Short-term use of antipsychotics in older adults with dementia linked to serious adverse events
3. Antipsychotics Dangerous for Elderly With Dementia
4. FDA Orders Warning Label on Older Antipsychotics
5. Newer antipsychotics no better than older drug in treating child and adolescent schizophrenia
6. Rutgers receives $2.3 million federal grant to research use, safety of antipsychotics
7. Most Newer Antipsychotics No Better Than Older Ones, Just Different
8. Antipsychotics Up Death Risk in Alzheimers Patients
9. Newer Antipsychotics Pose Cardiac Risk: Study
10. Newer Antipsychotics May Boost Weight in Alzheimers Patients
11. FDA Panel Mulls Newer Antipsychotics for Kids
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/5/2016)... New York (PRWEB) , ... February 05, 2016 , ... ... The answer may be at the tips of your toes. Foot massage, whether administered ... well as pure comfort and relaxation. The American Board of Multiple Specialties in ...
(Date:2/5/2016)... Illinois (PRWEB) , ... February 05, 2016 , ... ... and independent PROSHRED franchises from across the country gathered at the La Valencia ... recognize top performers. PROSHRED Chicago was named the year’s most outstanding franchise, ...
(Date:2/5/2016)... ... February 05, 2016 , ... Pivot Point Consulting, ... in KLAS: Software & Services for HIT Implementation Support & Staffing report with ... ranks vendor performance by healthcare executives, managers and clinicians representing over 4,500 hospitals ...
(Date:2/5/2016)... CA (PRWEB) , ... February 05, 2016 , ... ... Move from on one drop zone to the next using Colorize's dynamic moving camera. ... any project. This package includes a 3D slideshow environment with 1 to 5 focus ...
(Date:2/5/2016)... ... February 05, 2016 , ... Calls Blacklist has just been updated by mobile ... and the developer has fixed known bugs within the app. Calls Blacklist allows its ... while not consuming any of their device’s battery power or memory. It provides a ...
Breaking Medicine News(10 mins):
(Date:2/5/2016)... DUBLIN , Feb. 5, 2016 /PRNewswire/ ... the addition of the "Global Obstetrics ... company profile to their offering. ... addition of the "Global Obstetrics Partnering ... company profile to their offering. --> ...
(Date:2/4/2016)... 2016  The Senior Care Pharmacy Coalition (SCPC) ... Chairman Jason Chaffetz (R-UT) and Ranking ... hearing , "Developments in the Prescription Drug Market," ... questions about abusive pharmacy benefit manager (PBM) pricing ... Ranking Member Elijah Cummings (D-MD) are diligent, serious ...
(Date:2/4/2016)... Feb. 4, 2016  SciClone Pharmaceuticals, Inc. (NASDAQ: ... has entered into a settlement agreement with the ... resolving the SEC,s investigation into possible violations of ... terms of the settlement agreement, SciClone has agreed ... disgorgement, pre-judgment interest and a penalty.  This payment ...
Breaking Medicine Technology: