Elderly With Dementia Are Wrongly Given Antipsychotic Drugs, Inspectors Say

WASHINGTON -- Government inspectors told lawmakers Wednesday that Medicare officials need to do more to stop doctors from prescribing powerful psychiatric drugs to nursing home patients with dementia, an unapproved practice that has flourished despite repeated government warnings.

So-called antipsychotic drugs are designed 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 U.S. to pacify aggressive behavior related to dementia. Drugs like AstraZeneca's Seroquel and Eli Lilly's Zyprexa are known for their sedative effect, often putting patients to sleep.

But the drugs can also increase the risk of death in seniors, prompting the Food and Drug Administration to issue multiple warnings against prescribing the drugs for dementia. Antipsychotics raise blood sugar and cholesterol, often resulting in weight gain.

An inspector for the U.S. Department of Health and Human Services told the Senate Committee on Aging that the federal government's Medicare program should begin penalizing nursing homes that inappropriately prescribe antipsychotics, according to written testimony obtained by the Associated Press.

The Centers for Medicare and Medicaid Services provides health coverage to nearly 80 million senior, poor or disabled Americans.

HHS Inspector General Daniel Levinson proposed that Medicare force nursing homes to pay for drugs that are prescribed inappropriately, and potentially bar nursing homes that don't use antipsychotics appropriately from Medicare.

A report by Levinson's office issued in May found that 83 percent of Medicare claims for antipsychotics were for residents with dementia, the condition specifically warned against in the drugs' labeling. Fourteen percent of all nursing home residents, nearly 305,000 patients, were prescribed antipsychotics. The HHS Inspector General's office Medicare claims during a 2007 six month period.

Doctors are permitted to prescribe drugs for off-label uses, though it is illegal for drug companies to promote uses that haven't been cleared by the FDA. In recent years several pharmaceutical companies have paid huge fines to the Department of Justice in cases involving off-label marketing of antipsychotics.

In January 2009, Eli Lilly & Co. Inc. agreed to plead guilty and pay $1.4 billion for illegal promotion of Zyprexa, including marketing to nursing home doctors. The company told its sales representatives to use the slogan "5 at 5," to persuade doctors that giving 5 milligrams of the drug at 5 p.m. would make dementia patients sleep through the night.

AstraZeneca PLC has paid nearly $600 million in two separate settlements with federal and state prosecutors over alleged off-label promotion of its drug Seroquel.

Comments

[venlafaxine]

08:28 PM on 12/17/2011

Anti psychotics raise suicide by 25% even in none suicidal people along with a whole lot of nasty side effects. Very little is known about the brain or causes of illness. Even less about the medication and what it does. No one person is standard, so there is no telling how a person will react, to some it can make the mental condition worse. (No tests)

[venlafaxine]

08:16 PM on 12/17/2011

They don't work in the majority for what the were intended, people end up with tardive dyskenasia
Benzo are great at triggering psychosis & depression - Used too! All Psychotropic drugs are dangerous. Science knows very little about the brain. Psychiatry is based on theory only & still behind other areas of medicine. Little advances since the Victorian Era - based upon damaging.

[geri doc mc]

07:56 PM on 12/15/2011

There are no other effective treatments for severe paranoia, delusions and hallucinations except antipsychotics. Of course, there are times these medicines are not appropriate or side effects develop and therefore they should be stopped or changed, i.e. follow reasonable medical practice. However, when my grandmother became aggressive because she thought the ICU nurses were trying to kill her (which they weren't), she was reassured and helped with these medicines. In full disclosure, I sometimes prescribe these medicines for others but not unless there is a good reason.

[VA Jill]

03:23 PM on 12/04/2011

Happens all the time. Probably 80-90% of the patients I saw who had dementia were on some kind of anti-psychotic. The side effects of some of these drugs ought te be enough to deter their incautious use, but the docs, under the influence of Big Pharma, keep prescribing them.

[unique]

06:07 PM on 12/02/2011

By the way, do not be afraid to question the doctor
on why he is ordering the medication and what the
dosage and side effects are, and tell him if you want
your loved one off the medication. The doctor gets
paid by your insurance company and works for you.
You need to take an active roll.

[unique]

06:03 PM on 12/02/2011

My mother had Alzheimers while in an Assisted Living Facility.
Mom pushed over a chair that a lady was sitting in. The
Facility without my knowledge Psychiatrist who ordered
Mom who was 98 pounds and 58 inches tall Thorazine 100mg.
A couple of days later I saw Mom who was a Zombie, called 911
and had her taken to the hospital. The Psychiatriast never even
came to the Facility to see Mom, ordered the medication over the
phone. Her medical doctor took her off the Thorazine and she
never needed a psychiatric med again. The family needs to take
an active roll in the medication that the Alzheimers patient is ordered.
You can look up the meds and side effects on line and need to do so.

[Joy Twesigye]

12:12 PM on 12/02/2011

We need to desperately think outside of the box regarding care for the elderly. Nursing home care as it stands now just isn't suited for the complex needs and one and one care that we would like for our loved ones. For those with loved ones whose parents have mild to moderate dementia you may want to check out the Intergener­ational School in Cleveland OH. They have documented improvemen­t in people with mild to moderate dementia--­an interview with a co-founder is here http://vim­eo.com/327­56598

[popcorn39]

04:48 PM on 12/01/2011

Although I am sure there are many instances in which nursing homes/doctors over prescribe medications, particularly, anti-psychotics, I can't imagine not having these drugs as a resource for our loved ones (and their caregivers) who suffer from this horrific disease. If my father did not have access to his daily dose of Seroquel, he would not be living at home. He is not a zombie, but he is less aggitated, delusional and seemingly comfortable (as comfortable as one can be living with this disease day in and day out). I am so tired of "medical professionals" making blanket statements that scare people into thinking that there are no resources to deal with the difficult behaviors associated with this disease. Additionally, the risks involved ie: stroke, heart problems....who cares, anyone of these resulting side effects would be a welcome event if it lead to a quick and painless death (an opinion I know I share with my afflicted father). Remember, Alzheimer's is a terminal disease!!!!!!!!

[lezahgg]

04:44 PM on 12/01/2011

My elderly father had hallucinations that we believe were related to the shock of my mother's sudden death, his Parkinson's or his Parkinson's medications or perhaps all three. His doctor prescribed a low dosage of serequel and the hallucinations stopped and it calmed him down. He did not seem sedated--he just seemed like his normal self and we have no reason to believe that this medication shortened his life.

[AnneMarieDeSoto]

03:05 PM on 12/01/2011

My father had Alzheimer's, and though he could be quite difficult at times, even violent when he was severely frustrated, he was for the most part quite lucid...we'd go to the beach, out to eat, and he'd explain the rules of basketball to me...

But one misunderstanding led to another, and my father was put into a nursing home, and then tied to a wheelchair until he could no longer walk, and to pacify his anger, he was given large doses of Seroquel to "calm him down," and though it was nice not to see him upset, my father wasn't himself, either.

A nursing home worker quietly warned me that the patients prescribed this type of medication tended to die much sooner than those who were not, and sure enough he developed an enlarged left pupil, and died soon after. He had been in otherwise perfect health.

We must find ways to accommodate "difficult" patients other than just "drugging their issues away" in order to make things easier for their caretakers, and family MUST look out for their loved ones, talking things over with their medical providers, always seeking the best and least dangerous care plan possible.

[ctthea]

12:47 PM on 12/01/2011

My mother is on a very low dose of Seroquel and it helps her to sleep and not be up at night wandering, rummaging, and being paranoid. She has been diagnosed with Alzheimers and Dementia for almost 2 years. Careful monitoring is the key.

[hubbleman007]

11:44 AM on 12/01/2011

My mother who passed away in September, had terrifying experiences, seeing people who did not exist. She suffered from Alzheimer's, and before she started taking Zyprexa, saw people in her closet and people coming out of the walls. She was scared to death. After taking Zyprexa, she not only quit seeing these things, but actually became more rational.

Zyprexa may be used for the wrong reasons by some doctors, but a blanket statement banning it, is just wrong.

It has it uses, and it does work.

[wakohnen]

12:12 PM on 12/01/2011

makes one wonder if when we die or are close to death can we see into another dimension? Is there such a thing? I suppose there is only one way to find out. I am not ready to find out yet. Condolences on your mother's passing. May she rest in peace.

[venlafaxine]

08:19 PM on 12/17/2011

It might be Psychosis, the brain shutting down? Which Science & the Medical Profession like us to believe or medication side effects.

[MarkDaniels]

11:29 AM on 12/01/2011

Eli Lilly Zyprexa can cause diabetes.
I took Zyprexa Olanzapine a powerful Lilly schizophrenic drug for 4 years it was prescribed to me off-label for post traumatic stress disorder was ineffective costly and gave me diabetes.
*FIVE at FIVE*
The Zyprexa antipsychotic drug,whose side effects can include weight gain and diabetes, was sold for "children in foster care, people who have trouble sleeping, elderly in nursing homes.
*Five at Five* was the Zyprexa sales rep slogan, meaning *5mg dispensed at 5pm would keep patients quiet*.
-- Daniel Haszard Zyprexa victim activist
FMI
http://www.zyprexa-victims.com

[katr112157]

11:25 AM on 12/01/2011

Sounds like doctors will now be even more reluctant to prescribe the proper drugs for elderly schizophrenics (like my own mother) in nursing homes.