US care homes over-prescribing drugs for residents with dementia, report finds

Nursing homes in the US are inappropriately medicating an estimated 179,000 residents with dementia each week, in what amounts to use of “chemical restraints”, according to a new Human Rights Watch report.

The 157-page report, titled ‘They Want Docile’ claims thousands of long-term nursing-home patients with dementia are inappropriately given antipsychotic drugs not designed for them. In many cases, the report states, antipsychotics are prescribed because of their sedating effects, making dementia patients easier for staff to handle.

Antipsychotic drugs carry a serious warning from the US Food and Drug Administration called a “black box” because the drugs increase dementia patients’ risk of death. The drugs were developed to treat psychiatric conditions such as schizophrenia.

Hannah Flamm, an NYU law school fellow at Human Rights Watch: “People with dementia are often sedated to make life easier for overworked nursing home staff, and the government does little to protect vulnerable residents from such abuse.

“All too often, staff justify using antipsychotic drugs on people with dementia because they interpret urgent expressions of pain or distress as disruptive behavior that needs to be suppressed.”

The report comes as lawmakers and researchers are warning of a wave of aging baby boomers. Currently, more than 5 million Americans have Alzheimer’s, and one in three seniors dies with Alzheimer’s or another dementia. The number of people with Alzheimer’s could triple by 2050.

Researchers with Human Rights Watch interviewed 323 people and visited 109 nursing homes in California, Florida, Illinois, Kansas, New York and Texas between October 2016 and March 2017. They used federal data to estimate the percentage of patients nationally who inappropriately receive such drugs.

Researchers found instances where patients or their proxies (such as family members) were not told of the risks of antipsychotic drugs, or felt their loved ones would be removed from a facility if they were taken off the drugs.

“[It] knocks you out,” a 62-year-old woman from a nursing facility in Texas told HRW. She said she was given Seroquel, an antipsychotic drug, without her knowledge. “It’s a powerful, powerful drug. I sleep all the time. I have to ask people what the day is.”

In another instance, the director of a nursing facility in Kansas told HRW that, “antipsychotics are a go-to thing”.

Rates of nursing home residents on antipsychotic drugs have declined in recent years, but government reports have said there is more work to do.

The HRW report chimes with others, including a recent government report, which found high rates of antipsychotic drug use in US nursing homes.

For example, a federal government report found that in 2012, 33% of older adults with dementia who lived in nursing homes were prescribed antipsychotics, versus 14% who lived outside nursing homes.

The most common antipsychotics address conditions such as schizophrenia and bipolar disorder. However, the FDA has found the drugs are commonly prescribed for “off-label” disorders.

“The trend now is to reduce the use of antipsychotic medication, and to monitor and to use them as appropriate,” said a spokeswoman for LeadingAge, a lobbying group for nursing facilities.

The report follows the Trump administration relaxing regulations on nursing homes, which discouraged regulators from levying fines on violators.

HRW called on the government to step up efforts against antipsychotics use in nursing homes.The federal government pays for the majority of nursing home residents’ care through the public health program Medicaid.

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US care homes over-prescribing drugs for residents with dementia, report finds