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Antipsychotics: Nursing homes rethink use of drugs

Original source:

San Francisco Chronicle
Matt Sedensky, Associated Press
Sept. 15, 2011

Day after day, Hazel Eng sat on her couch, a blank stare on her face. The powerful antipsychotics she was taking often cloaked her in sedation. And when they didn't, the 89-year-old lashed out at her nursing home's aides with such anger and frequency her daughter wondered if her mother would be better off dead.

Until, in a matter of days, everything seemed to change.

Eng's daughter, Jean Lynch, says her mother was moved to a different section of the Ecumen home in North Branch, Minn., and taken off every drug but her daily aspirin. She now beams as she ambles the hallways, reads the newspaper, tells stories and constantly laughs.

"Now I hope she lives till she's 200 years old," Lynch said. "She's just so happy."

Antipsychotics are meant primarily to help control hallucinations, delusions and other abnormal behavior in people suffering from schizophrenia and bipolar disorder, but they're also given to hundreds of thousands of elderly nursing home patients in the United States to pacify aggressive and paranoid behavior related to dementia.

The drugs can limit seniors' ability to effectively communicate, socialize or participate in everyday life. But a series of warnings has prompted a movement of nursing homes trying to reduce the decades-old practice, often resulting in positive changes.

Still, doctors say the drugs are sometimes the only things that help the small number of dementia patients that display psychotic behavior, making them a danger to themselves and others.

A government audit released in May looked at Medicare payments for atypical antipsychotics, as a newer class of the drugs is known, and found in a six-month period that was analyzed in 2007, about 1 in 7 nursing home patients age 65 or older had been prescribed them. Since 2005, atypical antipsychotics have been under an FDA warning alerting doctors they could increase the risk of death in patients with dementia because of heart attacks or pneumonia. The most common atypical antipsychotics are sold under the brand names Risperdal, Zyprexa, Seroquel, Geodon, Abilify and Invega.

An older class of the drugs, known as typical antipsychotics, was added to the FDA warning three years later.

The warnings did not apply to other medicines widely used in nursing homes, such as the antidepressants Prozac and Paxil, and the anti-anxiety medicines Xanax and Valium.

Still, off-label use of antipsychotics has continued to be widespread. Some see it as a crutch, used to quiet seniors' outbursts or mask difficult personalities, though many others say it's the only pharmaceutical option to treat a patient with a cadre of behavioral problems.

The FDA's warnings on the drugs have led to nursing homes rethinking their use of antipsychotics. Dr. Izchak Kohen, a geriatric psychiatrist for North Shore-Long Island Jewish Health System, surveyed nursing homes across the country and found 39.1 percent had decreased their use of the drugs since the warning.