Improper Use of Antipsychotic Medication

The PDF in which this article appears can be found in Bifocal Vol. 44 Issue 3.

According to Human Rights Watch, in an average week, “179,000 residents of long-term nursing homes across the country are given antipsychotic drugs…that are not appropriate for their condition” (Lardieri, 2018). Doctors administer a lot of prescriptions for medications that are meant to help patients. There are a vast number of medications that are often used to treat different problems that we experience. A relatively small percentage of adults, about 1.6 % according to the NIH, are prescribed “antipsychotic medication” (Dennis et al., 2020). However, the Department of Health and Human Services’ Office of Inspector General found that in 2007, 14 percent of nursing home residents receiving Medicare benefits had claims for using an antipsychotic medication, and 83 percent of these claims were for off-label use of such medications, or for use for which there was no clinical indication” (Introcaso, 2018).

Responsible Use of Antipsychotic Medications

Antipsychotic medications are intended to be prescribed to people to help “manage mental health phenomenon known as psychosis” and typically are given to those suffering from schizophrenia and bipolar disorder (Todd, 2018). Antipsychotic medications have been empirically found to have dangerous side effects in middle age and older adults and can be more lethal in those living with dementia. The Federal Drug Administration (FDA) has given antipsychotic medications a black box warning to “increase the prominence of warning to the ‘learned intermediary’ or the physician…” (Upham, 2018). However, these medications can often be found in nursing home facilities to care for the elderly. The issue at hand is the dangerous and improper use of antipsychotic medication by middle-aged or older adults in skilled nursing homes, which can lead to an increase in mortality rate, movement disorders, motor side effects, strokes, and many other impairments.

Initially, antipsychotic medications were thought to provide “safe and effective” treatments for older adults dealing with psychotic disorders. However, this is no longer the case. From recent scientific observations, we are discovering new harmful side effects that stigmatize the notion that antipsychotic medications are more harmful than good when used to treat middle-aged or older adults. In one study, scientists “compared the safety and effectiveness of the four most commonly prescribed atypical antipsychotics (aripiprazole, olanzapine, quetiapine, and risperidone) in a group of 332 outpatients over the age of 40 years, with psychotic symptoms related to schizophrenia, mood disorders, PTSD, or dementia, over 2 years or treatment.” Throughout the experiment, over half the participants left due to side effects and lack of efficacy. The research concluded that “the rates of serious adverse events such as hospitalizations, deaths, and emergency room visits for life-threatening conditions were also high (23.7%) as were the rates of non-serious adverse events (50.8%) (Jeste and Maglione, 2015).”

Barriers to Proper Use of Antipsychotic Medications

Results of the study suggested that atypical antipsychotic medication was neither safe nor effective for middle-aged or older adults. The data from this study helped bring awareness to the dangers of antipsychotic medications, however, such medications are still improperly used in nursing homes today. Deriving information from the National Partnership to Improve Dementia Care in Nursing Homes’ “Antipsychotic Medication Use Data Report” (April 2022), antipsychotic medication usage has gone down about 8% in the past decade (from 2011-2021), but it has hit another plateau at about 15% from around 23%. If we do not continue to decrease the use of antipsychotic medications on older adults who do not need them, the aging population will continue to be hospitalized or die when the resources are there to prevent this from happening.

Questions often arise about how antipsychotic medications are used in nursing homes. If we know these medications are harmful to middle age and older adults, especially those with specific cognitive conditions like dementia, why are they continuously being used in nursing homes? Nursing homes sometimes use these medications to sedate their residents (Introcaso, 2018). Due to nursing homes being understaffed, the distribution of antipsychotic medication acts as a convenience for the staff rather than helping the residents. Reports from Human Rights Watch (HRW) have found that these medications are “frequently administered without the residents, or their families, or surrogates, free and informed consent or…without their awareness.” HRW also estimated that on an average week, “nursing homes administer antipsychotic drugs to more than 179,000 residents who do not have a diagnosis for which antipsychotic medications are approved.” Such residents have a higher risk of receiving unwanted side effects, being hospitalized, and an increased mortality rate.

There is legislation designed to primarily negate the use of antipsychotic medications in older adults, but such statutes have had little impact on the use of antipsychotic medications in nursing homes. Medications like Haldol, used to treat schizophrenia and control motor and speech tics for people with Tourette’s syndrome, are still administered to aging residents, luckily not as much as in previous years (Antipsychotic Medication Data User Report). The Department of Health and Human Services’ Office of Inspector General found that in 2007, 14 percent of nursing home residents receiving Medicare benefits had claims for using an antipsychotic medication, and 83 percent of these claims were for off-label use of such medications, or for use for which there was no clinical indication” (Introcaso, 2018).