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Increased use of anti-psychotics in nursing home residents

Published on July 22nd, 2009

The Philadelphia Inquirer had an interesting article about the increased use of anti-psychotics in nursing home residents. Sales of atypicals rose to $14.36 billion in 2008 from $8.4 billion in 2003, according to data provider IMS Health. Elderly patients have been a major source of that growth. Studies suggest that 20 percent to 30 percent of nursing-home residents take an atypical, despite not having a psychosis diagnosis.

This is a dangerous treatment since these medications have terrible side effects such as constipation, loss of appetite, lethargy, and increased risk of falls.  I always worry that their use is more to make thing easy for the staff then to help the residents. Nursing homes provide these medications because they may calm people and help them sleep.  Families of residents need to worry staff using these medications as a chemical restraint to subdue residents who complain about the poor care they are receiving.  The article discusses two specific residents and how one benefited and the other did not.

 Risperdal, Seroquel, Zyprexa, Abilify, and Geodon are atypical antipsychotics, a category of psychotropic drugs. These drugs are approved to treat schizophrenia and bipolar disorder despite mixed evidence that they help and ample evidence that they hurt. The drugs have life-threatening side effects, especially in the elderly. Several studies report they increase the risk of heart attacks, stroke, and premature death in this group. The atypicals now carry a so-called black box warning – the most serious required by the U.S. Food and Drug Administration – saying patients with dementia who take them are "at increased risk of death."

In February, California’s attorney general charged three nursing home employees with using Risperdal and Zyprexa to sedate patients and make them easier to manage. In a separate case in January, Lilly agreed to pay the federal government $1.4 billion to settle charges that it illegally marketed Zyprexa for use by the elderly.  As evidence surfaced that some elderly patients were being medicated into submission, Congress passed laws making overuse of psychiatric drugs, or "chemical restraint," illegal.

Laws trying to ensure proper use of psychiatric drugs require that nursing homes carefully monitor them, checking to see how patients respond and trying to reduce the dose or wean patients off them.  However, this is hardly ever done by well-trained or qualifed nurses.

Elaine Leventhal, director of the Gerontological Institute at the University of Medicine and Dentistry of New Jersey, said caregivers should try to manage behavior before turning to medications. She recommends that the family stay for dinner the day a relative is admitted to a nursing facility and visit as often as possible to ease the transition.

 

 

 

 

Joe Pioletti
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