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Top brain specialist calls for ban on antipsychotic in elders

Boston Globe
Kay Lazar, Globe Staff
May 16, 2011

A senior neurologist at Beth Israel Deaconess Medical Center says many hospitals inappropriately use the antipsychotic Haldol "like water" in agitated elderly patients, putting them at risk for serious complications.

Dr. Louis Caplan, a neurology professor at Harvard Medical School, said a recent government report that found pervasive use of antipsychotic medications in elderly nursing home patents underscores the "overuse" problem with this class of drugs.

Caplan said Haldol is typically given to agitated patients to calm them quickly, but he said older patients, especially, can become over-sedated and stiff, putting them at risk for pulmonary and urinary infections, because they have trouble moving and couging.

"I would love to see Haldol banned from use in hospitals," Caplan said. "It has no role to play in hospitalized, agitated patients."

A report released this month by the Inspector General's Office of the federal Department of Health and Human Services found that 51 percent of Medicare claims for a newer class of antipsychotics, known as atypical, were prescribed inappropriately to nursing home patients.

The Inspector General reviewed medical records from 2007 and and found that 83 percent of Medicare claims for atypical antipsychotic drugs for elderly nursing home residents were associated with conditions not intended for that use. The report also found that 88 percent were associated with a condition that could produce serious side-effects, conditions for which federal regulators had specifically warned against such usage.

The use of such drugs is especially worrisome in nursing homes because a substantial number of residents suffer from dementia, a condition that puts them at greater risk of death when given antipsychotic medications.

The drugs were developed to treat people with severe mental illnesses such as schizophrenia, not dementia, which is the progressive loss of memory or other intellectual function than can result from aging or Alzheimer's disease.

Fderal regulators have issued nationwide alerts about troubling and sometimes fatal side effects when antipsychotics are taken by people with dementia, including increased confusion, sedation, and weight gain

Haldol is an earlier class of antipsychotic drugs, but Caplan said it's just as problematical.

During the 14 year period that Caplan was chairman of the Neurology department at Tufts Medical Center and the Neurologist-in-chief, the hospital eliminated completely the use of Haldol in hospitalized patients in its neurology service, Caplan said in a letter he wrote to the Alliance for Human Research Protection, a patient group that has lobbied against the overuse of antipsychotic drugs.

Complications from the use of Haldol was one of the most common reasons for neurological referral for consultation at Tufts, Caplan said.

"It is also a common reason for referral at the Beth Israel Deaconess Medical Center," Caplan said.