The problem with oversedation in United States nursing homes
The use of dangerous medicines to sedate seniors with dementia has been a well-documented problem in nursing homes, especially in Kansas.
But according to a new study published by AARP, the problem is deeper.
AARP researcher Elizabeth Carter found that the improper use of anti-psychotic drugs is growing for seniors with dementia in assisted living or who live with family.
“I think there’s been a lot of interest (in the study) and a lot of surprise because the focus has traditionally been on the nursing home setting,” Carter said.
Using Medicare Advantage data, Carter found that 13.4 percent of seniors with dementia outside of nursing homes were prescribed an anti-psychotic in 2015, even though they didn’t have the mental health conditions those drugs are intended to treat.
That’s up from 12.6 percent in 2012, at a time when the use of the drugs in nursing homes was dropping.
“To see an increase, even if it was a slight increase — I think that surprised a lot of people,” Carter said.
Mitzi McFatrich, the executive director of Kansas Advocates for Better Care, said years of federal attention to over-medication in nursing homes has made medical directors and staff at those facilities more aware of the dangers of anti-psychotics, which carry risks of falls, stroke and other potentially fatal side effects.
Patients outside of nursing homes are seeing internists or family medicine doctors who might not be as aware of the issues.
“There might not have been the same kind of education among physicians in the community,” McFatrich said.
The federal government embarked on a campaign to curb anti-psychotic use in nursing homes in 2012, when nearly 25 percent of residents nationwide were being prescribed the drugs.
Since the campaign began, the national rate has dropped to about 15 percent.
But Kansas nursing home representatives have long argued that they’re not the sole source of the problem.
Cindy Luxem, the president and CEO of the Kansas Health Care Association, said the AARP study provides more evidence of that.
“We believe only about 2 percent of folks are prescribed (an anti-psychotic) after they enter a facility,” Luxem said via email. “They are coming in already prescribed, whether from the hospital or community setting.”
McFatrich’s group has been pushing for a bill to strengthen Kansas' informed consent laws governing what nursing home residents and their families are told about medications before they’re given.
There was a hearing on the measure in March, but it hasn’t advanced.
McFatrich said the AARP study has raised more questions for her. For instance, why did Carter find that women were more likely than men to be put on an anti-psychotic?
McFatrich said she hopes Kansas officials will consider creating a statewide plan to address dementia care in every setting, including best practices, training standards and resources for caregivers, as well as non-pharmaceutical options for calming people with dementia when they are distressed.
“If we know there are things that can be done that don’t put a person’s life or quality of life at risk, why aren’t we promoting those things?” McFatrich said.
Carter’s study excluded seniors with schizophrenia, bipolar disorder, Tourette syndrome or Huntington’s disease, treating those as legitimate uses of anti-psychotics. The federal data on nursing home residents only excludes those diagnosed with schizophrenia, Tourette or Huntington’s.
Carter was not able to break her data down by individual states.
She said her report does suggest that many nursing home residents come into facilities already on anti-psychotics. But that doesn’t mean nursing homes are off the hook.
“Just because someone comes in on a drug doesn’t necessarily mean it’s appropriate to keep them on the drug,” Carter said. “Especially given the side effects that are associated.”