When nursing home residents recalled not being able to think properly, staying awake, and speaking incoherently, their children knew there was a problem. Recently, a CNN investigation has found that nursing homes often give dementia patients antipsychotic drugs without any proper diagnosis of a mental illness and without receiving the proper consent.
This is a part of some of the discoveries stated in the new report of the Human Rights Watch. This 157-pages report that was published recently made an estimation that more than 179,000 senior citizens living in nursing homes in the US receive antipsychotic medications without thorough and approved diagnoses, such as schizophrenia, to authorize the use of this kind of medication.
Since the residents are mostly older people with dementia, these drugs are effective and save money when managing their behavior. They also used these drugs to lighten the workload of the nursing home staff. However, the use of antipsychotic medication for dementia patients puts them at risk and opens the door for a number of different accidents.
The report corresponds with the results of an investigation conducted by CNN last October. In this story, Nuedexta, which is a small red pill, was given and overly prescribed in nursing home facilities. Moreover, the drug manufacturer of this drug greatly benefited monetarily, specifically from the US government, because of overprescription. The report by CNN initiated an investigation of a pharmaceutical company that is based in California.
The researchers from the Human Rights Watch went to 109 institutions in 6 different states between October 2016 and March 2017 to validate reports about residents of nursing homes being overmedicated with other drugs apart from Nuedexta. They were able to talk to over 300 people, which includes nursing home residents, their family members, social workers, experts in giving long-term care, pharmacists and many more. Their findings were not only disturbing, but also perilous.
What has the FDA said about the use of antipsychotic drugs for patients?
The FDA or Food and Drug Administration has not considered taking antipsychotic drugs as a safe or effective method to relieve the dementia-related symptoms that include psychosis associated with dementia. In fact, there is no drug that has been approved for this condition.
So, the FDA warns elderly patients with dementia the possible dangers that increase the risk for death when taking this particular drug. Nervous system problems like jerking and severe rigidity of the muscles, high blood sugar, blood clotting, and low blood pressure are some of the other adverse effects patients may suffer.
More details on the investigation
The researchers found that the risk of this drug was not explained to some family members. Some were forced to give consent in its administration because their loved one will be forced out of the institution if not.
After the residents stopped taking antipsychotic drugs, improvements in their conditions were seen by the residents themselves and their family members. One daughter saw a drastic improvement in her 90-year-old mother’s condition 2 years after she discontinued taking this drug as she saw her mother talking, reading and walking. When her mother was on the medications, she could not remember well and recognize other people. Moreover, she talked incoherently and slept most of the time.
There are various ways to deal with symptoms related to dementia that do not require patients to take medications. Making routines, offering activities, building healthy relationships with nursing home staff, lessening loneliness, creating programs such as music or pet therapy and exercising are some of the many things that can be done to see improvements on these patients.
This information is highly vital as the American population ages. Currently, there are almost 50 million who are over the age of 65. This figure is expected to be twice as large by the year 2060 as stated by US Census Bureau. Today, 5 million people have Alzheimer’s Disease or dementia in other forms. The Alzheimer’s Association predicts that that current number of people having dementia may reach to approximately 16 million in the year 2050.
So, who is responsible for this incident?
For Human Rights Watch, they actually blame the government because it is stated under the Nursing Home Reform Act of 1987 that the rights of the residents must be protected. This finding is not new. Although the government has known the existence of the problem of overprescribing antipsychotic drugs, it was not able to completely monitor its usage.
The Centers for Medicare & Medicaid Services even created the National Partnership to Improve Dementia Care in Nursing Homes to acknowledge this matter. In a statement sent to CNN through email, the use of these drugs was decreased to 35 percent.
It was also noticed that there have been developments due to some facilities not allowing the administration of antipsychotic medications to residents. According to a director to one of the nursing facilities in Kansas, their nursing home was like a prison due to half of their residents taking this kind of drug.
And, not all nursing homes are taking the same action as the Kansas nursing facility did. The problem still continues as stated by the human rights group. Seven thousand subpoenas were issued for institutions that violated the overprescription of antipsychotics between 2014 and middle of 2017. However, there has been no serious penalties given, so a significant change is not seen. For the Centers for Medicare & Medicaid Services, they insist that there is more that can be done.
During the administration of President Barack Obama, one of the plans was to make stricter regulations regarding this issue. However, in November 2017, the Centers for Medicare & Medicaid Services had suspended this action.
What can be done to solve this issue?
Some reports say that the current government can do a lot. It can completely ban the imprudent dispensing of antipsychotic medications by making stricter and more severe penalties and regulations, requiring informed consent, giving proper and ample training and staffing in nursing homes, and doing better inspections.
The Centers for Medicare & Medicaid Services claimed that it has been working really hard to make more improvements by implementing goals before 2017 ended. One of the goals is to lessen the use of antipsychotics by nursing institutions to 15 percent towards the end of 2019. The same requirement, which is for the patients to be free from the forced administration of medications, will remain. Instead of placing a fine on facilities that will not follow the policies, they will be given a transition period of 18 months to put more money into compliance and education. All these efforts are part of the aim to lessen the load on these health care institutions and safeguarding the welfare, rights, safety and health of their residents.
Orrin Hatch, a senator from Utah, said that it is very important for seniors who depend on Medicaid for their long-term support and care to be protected and kept safe in nursing homes that they consider home. He also mentioned that Medicaid expends billions of dollars for nursing homes so that they provide excellent care that old people deserve. Therefore, people, in general, must be watchful of how this organization works.
Finally, although improvements are slowly seen, more must still be done to protect the senior citizens from forcibly being prescribed to take antipsychotic medication. Not only old people are affected by this issue but their family members are as well. Therefore, it must be addressed and taken more seriously.