A few short years ago, 25% of all people residing in the long term care facilities were prescribed one or more anti-psychotic drugs. Usage had reached epidemic proportions, turning many of our clients into zombie like people to be found lolling in wheelchairs in front of the television, head dropped to one side, drooling. Attention was drawn to this crisis at the national level,with senate hearings, and commitments from CMS (Center for MediCare and MediCaid Services) to work to bring the usage down.T
That was three years ago. Since that time the national figures are showing an 18.8% reduction. California formed its own coalition working on several levels, including informing the medical practitioners who prescribe the drugs and the public at large, especially family members, of the inherent dangers in this class of drugs. As a result of the hard work of the coalition, the usage in California has dropped to 15.8% (a drop of26.5% from the baseline). Here in San Mateo County, the latest figures show an average of 9%, with several of our facilities way below that. Our facilities and the medical practitioners are to be commended for that effort. We still have work to do as we still have some nursing homes above the national average. We are meeting with nursing home administrators in an attemptto identify a best practice model that can be shared with those facilities that continue to struggle.
The public has been made aware by the media of several lawsuits brought against major drug companies for marketing this class of drugs for treating dementia. The drugs are in fact notapproved for this usage, and have been largely shown to be ineffective for such usage (though there are exceptional cases where they seem to have had some effect). The law suits haveresulted in astronomical fines or in some cases settlements with drug companies. But there was a shift in that trend recently when a nursing home in Ventura was fined for inappropriatelydrugging their residents, basically using the drugs as chemical restraints to keep them quiet and reduce the number of staff needed to provide care. This is a far different approach from fining the drug companies, but now a precedent has been set to hold facilities and medical practitioners accountable.
A critical element in all of this, and one that is often overlooked, is that California law requires the attending physician or surgeon of a resident within a nursing home to obtain informedconsent of the resident prior to prescribing, ordering or increasing a prescription of anti-psychotic medication. This law has been on the books since 1992, and is still significantly ignored by prescribers. If residents or their legally responsible family members knew of the dangerous risks and side effects of these drugs, it is doubtful they would agree to take them. The Black Box Warning accompanying the drugs says it all:
WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA RELATED PSYCHOSIS Elderly patients with dementia-related psychosis treated with anti-psychotic drugs are at an increased risk of death. ……………………. (fill in the blank) is not approved for the treatment of patients with dementia-related psychosis.