GAO Report Urges Fewer Antipsychotic Drugs For Dementia Patients

Mar 2, 2015
Originally published on March 3, 2015 1:16 am

Older adults with Alzheimer's Disease or other forms of dementia are at risk of being prescribed dangerous antipsychotic medication whether they live in nursing homes or not. That's according to a study from the Government Accountability Office published Monday.

The chance of a person with dementia receiving antipsychotic drugs in a nursing home is about 1 in 3, according to the report. For dementia patients who aren't in nursing homes — those living with family, for example, or in assisted living — the chance of being prescribed an antipsychotic is about 1 in 7.

These drugs are used to control the challenging behaviors that sometimes go along with Alzheimer's, but they are not approved by the Food and Drug Administration for that use. In fact the FDA has slapped these drugs with a strong warning, saying they can increase the chance of death for older adults with dementia.

"They blunt behaviors. They can cause sedation. It increases [a patient's] risk for falls," says Bradley Williams, a geriatric pharmacist who teaches pharmacy and gerontology at the University of Southern California. He says antipsychotics should be given to dementia patients for as brief a time as possible, and only if they have certain extreme symptoms, that have not responded to other therapies. That's not the majority of patients.

"And, if you just want to get to the very basic bottom line," he says, "why should someone pay for something that's not needed?"

It's Medicare that's usually paying for the drugs – such as Risperdal, Seroquel or Zyprexa. The medicines are approved by the Food and Drug Administration to treat symptoms of schizophrenia and bipolar disorder, but not symptoms of dementia.

Senator Susan Collins (R-ME) called the report troubling. She's the chair of the Senate's Special Committee on Aging, and one of the senators who asked the GAO to look into the matter.

"The report," Collins says, "raises many red flags concerning the potential misuse and excessive use of antipsychotic drugs for patients with Alzheimer's and other dementias who are living in nursing homes." In a written statement she noted that the report found that "factors unrelated to the patient — such as low staffing levels — contributed to the overprescribing of antipsychotic medications."

In 2012, the federal Centers for Medicare and Medicaid Services launched a campaign to reduce the use of these drugs in nursing homes. In fact, usage in those institutions is declining. The GAO report says the government needs to put the same effort into curbing the use of antipsychotics among patients with dementia who reside in assisted living centers or with their families.

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In December, NPR reported that nearly 1 in 5 nursing home residents takes dangerous antipsychotic drugs. That's despite a strong warning from the FDA saying that these drugs can be lethal for older people with Alzheimer's or other forms of dementia. Well, now a report from the GAO, the Government Accountability Office, finds that antipsychotic drugs are also overprescribed for dementia patients who don't live in nursing homes. NPR's Ina Jaffe reports.

INA JAFFE, BYLINE: According to the GAO, about 1 in 7 older adults with dementia who don't live in nursing homes were taking antipsychotic drugs in 2012. While this is not as high as the percentage of nursing home residents on antipsychotics, it's still evidence of a tendency to give potentially harmful drugs to deal with the behaviors of people with Alzheimer's or other dementias.

Professor Bradley Williams teaches pharmacy and gerontology at the University of Southern California. He says antipsychotics should only be given to dementia patients as a last resort.

BRADLEY WILLIAMS: They blunt behaviors. They can cause sedation. It increases their risk for falls. And if you just want to get to the very basic bottom line, why should someone pay for something that's not needed?

JAFFE: It's Medicare that's usually paying for such drugs as Risperdal or Seroquel. They're approved to treat serious mental illnesses like schizophrenia and bipolar disorder but not symptoms of dementia. In 2012, the federal Centers for Medicare and Medicaid Services launched a campaign to reduce the use of these drugs in nursing homes. And in fact, usage there is declining. The GAO report says the same effort needs to be put into cutting the number of dementia patients taking antipsychotics in assisted living or in their own homes. Ina Jaffe, NPR News. Transcript provided by NPR, Copyright NPR.