Cutting use of antipsychotic drugs in Alzheimer’s

  • Once again, antipsychotic drugs are in the news. Often used to control symptoms of agitation and aggression in people with Alzheimer’s, antipsychotics occasionally have their place. However, during the last few years there’s been an outcry from agencies and the public because nursing homes and doctors have often misused the drugs. Now, the U.S. Centers for Medicare & Medicaid Services (CMS) is officially aiming to cut the use of these drugs by 15 percent.


    Recently a Boston Globe article reported on the CMS action. The article quoted Federal regulators as saying that “nearly 40 percent of residents with dementia were receiving the powerful sedatives though they did not have a condition that would warrant it.”

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    According to the CMS, antipsychotics have sometimes-lethal side effects. The U.S. Food and Drug Administration issued two warnings since 2005 against using them in elderly patients with dementia. The announcement advises that this reduction is only a first step. In 2013, they aim to set another goal to cut the use of antipsychotics for dementia patients even more.


    The Globe article quotes Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, a national trade group, as saying, “We believe these antipsychotics are overprescribed…Many clinicians, physicians, and family members believe these medications are useful and necessary, but data show otherwise.’’


    Nursing homes aren’t required to follow these guidelines, but many larger agencies are going to try.


    Antipsychotics seen as a chemical restraint


    Many nursing home culture change groups, such as the Pioneer Network, have long decried the use of antipsychotics, saying that the need for drugs is dramatically reduced when experienced staff members give appropriate attention to the person in distress. The Pioneer Network has worked hard for over two decades to advocate for this type of person-centered care.


    Physical restraints to control nursing home residents are illegal in most states, except under special circumstances. Chemical restraints, however, are harder to define. Some people have illnesses that legitimately call for the use of antipsychotics, but this method can become abused in understaffed nursing homes. Overmedicating elders creates the “zombie” effect that many people associate with nursing homes residents. In these cases, people are given drugs to “calm” them to the point that they sleep most of the time and don’t cause disruption in the home’s care schedule.


    Thankfully, hands-on care now replaces overmedicating as the approach to calm residents and improve their quality of life in the best nursing homes. I saw person-centered, hands-on care during the years that several of my loved ones lived in a fine local nursing home. The staff was careful that the residents didn’t sleep more than necessary and were not over-medicated. I now realized how forward thinking the administration of this nursing home was. The more I study culture change in nursing homes, the more I appreciate the good facilities.


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    Our elders deserve to live their last years with as much quality of life as they are able to have. Drugging them into oblivion for the convenience of staff is no longer acceptable, if it ever was. I’m extremely happy to see the CMS onboard with these changes. This attitude bodes well for the future care of our aging population.


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    Lazar, K. (2012, May 31) US aims to cut use of drugs on dementia patients. Boston Globe. Retrieved from


Published On: June 12, 2012