Needless Antipsychotic Prescribing Runs Rampant in Nursing Homes

American nursing homes are overprescribing antipsychotic drugs, according to a new study.

In an average week, more than 179,000 older people, many with dementia, are given antipsychotic medications without a diagnosis for which the drugs have been approved and often without their or legal proxies’ informed consent, according to the study by Human Rights Watch.

Flamm

Human Rights Watch investigated the misuse of antipsychotic drugs in U.S. nursing homes because the issue crystalizes the vulnerability, isolation, and lack of accountability many residents face, according to study author Hannah Flamm, fellow at Human Rights Watch.

For the study, Human Rights Watch conducted extensive background research, analyzed publicly available data on the nation's nursing facilities, and visited more than 100 facilities in six states with antipsychotic drug administration rates above the national average. Geographically diverse states with varying performance with respect to antipsychotic drug use were chosen.

“Numerous studies have shown that these drugs offer little benefit to people with dementia and put them at significantly increased risk of death and other negative health outcomes,” says Flamm. “Nursing facilities often use these drugs because of their sedative effect. The use of the drugs as chemical restraints is prohibited by federal regulations and many state laws. But enforcement of these prohibitions is often ineffective.”

According to Flamm, healthcare executives have a responsibility to ensure that care provided to residents of nursing homes, among other institutions, is compliant with domestic regulatory standards. “We found that leadership from the top was seen as an important factor in many of the nursing facilities we visited that had drastically reduced their reliance on antipsychotic drugs,” she says. 

The misuse of antipsychotic drugs in nursing facilities is not a new phenomenon, Flamm says. 

“Human Rights Watch framed the issue as a potential violation of Americans' human rights due to the dangerousness of the drug, the rationale for administering them-for the convenience of the facility as opposed to a medical need-and the failure to seek or obtain informed consent prior to the administration,” she says. 

In interviews with facility staff who had recently succeeded in reducing the prevalence of off-label antipsychotic drug use in their facility, “Human Rights Watch heard repeatedly that discontinuing the inappropriate use of the drug was not only better for the quality of life of the resident, but also better for the staff,” Flamm says. “Medications that sedate make it easier to warehouse people but it often makes the task of caring harder as people are less mobile and health problems may go unnoticed until severe complications emerge.” 

Healthcare executives should ensure staff at all levels understand their obligations under the law, licensing, and ethics vis-à-vis antipsychotic drugs, according to Flamm.

“The Nursing Home Reform Act requires nursing facilities to provide care that enables residents to attain or maintain their highest practicable well-being. Such a standard should not be aspirational or negotiable,” she says.