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"Drugs used at Kern nursing home can be deadly for elderly"

Original source:

The Bakersfield Californian

BY STACEY SHEPARD, Californian staff writer | Friday, Feb 20 2009 7:06 PM

Three of the four drugs allegedly over-prescribed to patients at a Lake Isabella nursing home can pose such deadly side effects to the elderly that they bear the U.S. Food and Drug Administration's "black box" warning label.

Zyprexa, Resperidol and Seroquel were developed to treat severe psychotic disorders, such as schizophrenia, but are increasingly given to nursing home residents, often to treat behavioral issues, said Dr. Kathryn Locatell, a geriatric physician who specializes in forensic investigation of elder abuse.

Because the drugs can cause sudden death in elderly patients, said Locatell, they bear the FDA's strongest designation for medications that may have life-threatening side effects.

Locatell helped the California Attorney General's office investigate the Kern Valley Healthcare District's skilled nursing facility. That investigation resulted in the arrest Wednesday of a physician, a nursing supervisor and a pharmacist.

Locatell declined to talk specifically about the case. But she did speak about the growing use of anti-psychotic drugs to manage patient behaviors.

"Doctors are just giving it out like candy and nurses are administering it without any knowledge of what to look out for," she said. "And they're being prescribed for behavioral problems - things like 'resisting care.'

"It's like they're being drugged to quell the behavior instead of someone investigating why the behaviors are happening and coming up with a more humane approach. It really does boil down to what some believe is convenience."

The attorney general's office has charged that at least 22 patients were over-medicated at the Kern Valley facility, sometimes against their will, to calm and control them. Three residents are believed to have died as a result; two of them received one or more of these drugs, according to the criminal complaint. Interviews with nurses cited in the complaint said the drugging was done primarily to residents who acted out, complained or were "troublesome."

Dr. Tai Yoo, chairman of the Kern Medical Center's psychiatry department, said the drugs have unique effects in the elderly, who don't metabolize medication as quickly as young people.

"Prescribing these kind of medications routinely in this kind of nursing home is a very dangerous practice," Yoo said.

The drugs stay in the elderly longer, he said, and a high doses given for a long time can cause multiple complications and side effects. If used at all, they should be given in very low doses for a short period of time, he said.

Common side effects in the elderly are constipation, risk of falling and difficulty swallowing, which can lead to dehydration, weight loss and other life-threatening problems.

In most cases, the risks or prescribing the drugs to elderly patients far outweigh the benefits, Locatell said.

Known as atypical anti-psychotics, Zyprexa, Resperidol and Seroquel are relatively new medications. They are also rank as some of the most-expensive and, more recently, top-selling pharmaceuticals on the market.

Locatell said the drugs are heavily marketed to doctors who care for the elderly.

The use of chemical restraint in elder-care facilities is not a new problem. However, it's unethical, and if given without consent of the individual or a healthcare proxy, illegal.

Locatell said national statistics show about 50 percent of nursing home residents are on some form of psychotropic medication. Most are on anti-depressants, which she considers OK since there's high incidence of depression among nursing home residents. But about 30 percent of residents are now on anti-psychotics, a class of psychotropics designed to treat serious mental illness. The use of those drugs in a nursing home should "raise a flag" for loved ones, she said.

"As far as I'm concerned, it's replaced the use of physical restraints," said Nona Tolentino, former director of the county's adult protective services program who now oversees the long-term care ombudsman program at Greater Bakersfield Legal Assistance. "That's what I see and that's what we hear. There are behavioral problems in a nursing home and staff readily presents that to a doctor and the doctors agree to prescribe the drug or increase the dosage."

"And family members don't know what that might mean eventually."

The use of anti-psychotic drugs in the elderly can pose serious risks. Geriatric physician Kathryn Locatell and longterm care ombudsman Nona Tolentino said people with a loved one in a nursing home, skilled nursing facility or other residential care setting should asked for detailed information about medications.

Here are some questions to ask:

  • What medication is my loved one on?
  • What are you trying to treat with this drug? What are the specific behaviors that need treatment?
  • How will this drug improve my loved one's condition?
  • How often and how long will it be administered?
  • What are the side effects?
  • Has a doctor examined my loved one to determine if this is appropriate?
  • How will side effects be monitored?
  • Why are drugs even being considered?
  • What other approaches could be used? What has been tried?

"If you can't get good answers, then ask for a meeting with the director of nursing or the pharmacist," Tolentino said. Or, seek an outside pharmacist's opinion. Facilities should also have a "care plan" for each resident or patient. Ask for a meeting to review it with facility staff.