CCHR International » dementia

Are Nursing Homes Over-Drugging Their Residents?

admin — Wed, 26 Oct 2011 19:21:29 +0000

SF Weekly – October 26, 2011

by Peter Jamison

Click image to watch video: Psychiatric Abuse of the Elderly

According to the San Francisco-based organization California Advocates for Nursing Home Reform (CANHR), more than 25,000 California nursing-home residents are being given anti-psychotic drugs. That’s about a quarter of the state’s nursing-home population, and according to CANHR and other elder-rights activists, it’s a figure that’s way too high — particularly considering the negative side effects these medications can have.

“They’re being sedated into zombie-hood,” says CANHR staff lawyer Tony Chicotel. He adds that anti-psychotic medications increase the risk of death among seniors, are prescribed in place of more effective non-drug methods for handling patients with dementia, and are often give without obtaining patients’ consent.

“They’re very rarely asked whether they want to take the medication,” Chicotel says.

For More information watch this video or read all the facts here

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JAMA: Spotty results with off-label antipsychotic use

cchrint — Wed, 28 Sep 2011 19:00:39 +0000

FiercePharma
By Tracy Staton
September 27, 2011

Off-label use of powerful antipsychotic drugs has come in for plenty of debate in recent years. The expensive, newer-generation “atypicals” have been used to treat dementia, depression, anxiety, post-traumatic stress disorder, dementia, attention-deficit hyperactivity disorder…the list goes on. And all this while the Justice Department was investigating Big Pharma for off-label promotion of the drugs.

An updated analysis now finds that antipsychotic drugs’ utility in off-label uses is minimal, but the risks are significant, Medscape reports. Several illnesses didn’t respond at all to antipsychotic therapy, the data showed, including eating disorders and addiction problems. The evidence for treatment of personality disorders was a toss-up. Meanwhile, side effects were sometimes severe, including weight gain, metabolic problems, fatigue, urinary tract symptoms and even an increased risk of death, the researchers said.

A few off-label uses won support from the new data. Anxiety patients got moderate benefit from AstraZeneca’s ($AZN) Seroquel, and OCD sufferers were helped by treatment with Johnson & Johnson’s ($JNJ) Risperdal. Elderly patients with dementia saw a small benefit with antipsychotic use.

“We need to use this information and be wary of prescribing when it isn’t warranted,” said Dr. Alicia Ruelaz Maher, lead author of the JAMA-published study. “I think the biggest takeaway is that instead of just prescribing blindly, we now have evidence to guide us.” And, as Maher told Reuters, “Each individual patient needs to be considered as opposed to, ‘This is good for this condition.’”

http://www.fiercepharma.com/story/jama-spotty-results-label-antipsychotic-use/2011-09-28

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Two High Ranking Senators – Grassley & Kohl – Question Use of Psych Drugs in Nursing Homes

admin — Mon, 15 Aug 2011 21:59:15 +0000

MedPage – August 15, 2011

Emily P. Walker

Click image to watch video: Psychiatric Abuse of the Elderly

WASHINGTON — Two high-ranking senators have urged the Centers for Medicare and Medicaid Services (CMS) to take a closer look at potential over-prescribing of atypical antipsychotics to nursing home residents.

There are eight atypical antipsychotics approved by the FDA to treat schizophrenia and/or bipolar disorder, including clozapine (Clozaril), aripiprazole (Abilify), and quetiapine (Seroquel).

Atypical antipsychotics are not approved to treat dementia, and must carry black box warnings that elderly people who take atypical antipsychotics have an increased risk of death, compared with those who take placebo pills for dementia.

Still, it’s clear that these drugs are being used in nursing homes to control behavioral problems related to dementia. A 2011 report from the Department of Health and Human Services Office of the Inspector General (OIG) found that 14% of all nursing home residents with Medicare had claims for antipsychotics and 88% of the atypical antipsychotics prescribed off-label were for dementia.

And in 2009 Elli Lilly, the makers of olanzapine (Zyprexa), pled guilty and paid $1.4 billion to the federal government for allegedly targeting doctors who worked in nursing homes and assisted living facilities to prescribe olanzapine off-label to elderly patients with dementia.

In their letter, Sens. Charles Grassley (R-Iowa) and Herb Kohl (D-Wisc.), urged CMS administrator Donald Berwick, MD, to examine the issue of overuse of antipsychotics in nursing homes more closely. The letter is a follow-up to one the senators sent in May after the release of the OIG report, which the senators themselves requested.

The newest letter, sent Aug. 1, requests that CMS investigate what role pharmacy benefit managers — who manage prescription drug coverage for Medicare beneficiaries living in nursing homes — play in fueling the possible overuse of atypical antipsychotics in elderly people in long-term-care facilities.

Pharmacy benefits managers may receive rebates from drug companies for prescribing certain drugs, and CMS should look at their role in “unnecessarily increasing the use of antipsychotic drugs and to subsequently take action to address such practices and curb excess use.”

The letter also urges CMS to consider requiring that physicians, who off-label prescribe drugs with black box warnings to seniors, certify that a Part D provider will cover the drug.

If CMS followed the senators’ advice, Medicare payments for antipsychotics that “lack a medically-accepted indication” should be drastically reduced, the senators said.

“Taking such proactive steps will create disincentives for entities that administer pharmacy benefits to allow these practices to flourish while also providing CMS with clearer means to recoup erroneous payments,” Grassley and Kohl wrote.

A recent study found that the prescription cost for a typical antipsychotic increased from $38 to $41 between 2004 and 2008, while the price tag for an atypical antipsychotic rose from $226 to $323, the researcher found. Overall, the cost of typical antipsychotics in the U.S. was $600 million in 2008, while the cost of atypical drugs reached $9.9 billion.

That same study concluded that atypical antipsychotic use is growing, especially among seniors, and the drugs are increasingly prescribed off-label, sometimes without convincing evidence to support that use.

In 2008, 91% of the prescriptions written for atypical antipsychotics were for circumstances where the evidence for the efficacy was uncertain, the researchers found.

However, a separate study found that after the FDA issued a black box warning about the risks of using the drugs to soothe behavioral problems in dementia patients, there was a decline in prescribing the drugs to patients in the VA medical system.

http://www.medpagetoday.com/Geriatrics/Dementia/28052

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Attorney General Alleges Jansen Illegally Marketed Antipsychotic Drug – to kids and the elderly

admin — Tue, 02 Aug 2011 22:57:32 +0000

Coakley alleges Janssen illegally marketed drug

By Jessica M. Karmasek – LegalNewsLine.com

August 2, 2011

BOSTON (Legal Newsline) — Drug manufacturer Ortho-McNeil-Janssen is being sued by Attorney General Martha Coakley for illegally marketing Risperdal, an atypical antipsychotic medication.

Coakley’s lawsuit alleges that Janssen promoted the drug to treat elderly dementia and a number of uses in children and adolescents when these uses had not been shown to be safe and effective and had not been approved by the U.S. Food and Drug Administration.

The complaint, filed this week in Suffolk Superior Court, further alleges that Janssen failed to disclose serious risks associated with Risperdal’s use, including the risk of excessive weight gain, diabetes and, for elderly dementia patients, an increased risk of death.

“Manufacturers should not promote uses of their pharmaceutical products that have not been established to be safe and effective,” Coakley said in a statement Monday.

“Janssen put profits ahead of patient safety by promoting Risperdal for uses that had not been approved and by failing to disclose serious risks associated with Risperdal’s use.”

According to the attorney general’s lawsuit, Janssen’s unfair and deceptive practices included:

* Omitting and/or concealing material facts regarding Risperdal’s efficacy and safety in its communications with Massachusetts health care providers and consumers;

* Concealing, omitting or minimizing the side effects and risks associated with Risperdal’s use;

* Promoting Risperdal to treat elderly dementia without disclosing to prescribers the serious risks associated with Risperdal’s use in dementia patients, including an increased risk of death;

* Promoting Risperdal to treat elderly dementia without disclosing to prescribers that the U.S. Food & Drug Administration had rejected the company’s request to market Risperdal for this use because of unaddressed safety concerns;

* Promoting Risperdal’s use as safe and effective to treat conduct disorder and other conditions in children for more than a decade before receiving FDA approval to market Risperdal to treat any conditions in children;

* Making misleading and deceptive statements to prescribers about Risperdal’s safety, particularly with respect to weight gain and the risk of developing diabetes;

* Paying physicians to participate in sham consulting programs that were, in fact, thinly disguised marketing programs touting unapproved uses; and

* Targeting its sales and marketing efforts to prescribers who rarely, if ever, prescribe Risperdal for its FDA-approved uses, primarily the treatment of schizophrenia and bipolar mood disorder.

According to the attorney general’s complaint, Janssen’s illegal marketing and sales tactics helped the company generate hundreds of millions of dollars in sales in the state.

Citing company documents, Coakley’s lawsuit notes that these illegal tactics helped make Risperdal a market leader in both the children and adolescent and elderly market segments.

http://www.legalnewsline.com/news/233450-coakley-alleges-janssen-illegally-marketed-drug

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Five dementia sufferers die every day from antipsychotic drugs

admin — Fri, 22 Jul 2011 17:27:29 +0000

The Telegraph – July 22, 2011

By Martni Beckford, Health Correspondent

Five dementia sufferers die each day after being wrongly prescribed “chemical cosh” drugs, the Department of Health has warned.

Click image to read: The Psychiatric Abuse of Our Elderly

Many more hospital patients and care home residents suffer strokes triggered by the antipsychotic medications they are given to keep them sedated.

New GP-led bodies that will purchase services under the reformed NHS are being told to review the prescriptions of all 180,000 dementia sufferers currently prescribed the drugs, and to do all they can to give them alternative treatment.

A Dementia Commissioning Pack published on Thursday by the Department of Health states: “Thousands of people across England who are living with dementia are taking antipsychotic medication that they do not need and that could possibly harm them.

“Evidence tells us that although there are clinical situations where a time-limited prescription of antipsychotic drugs may be appropriate, antipsychotic drugs are often overprescribed and continued when alternative therapies are more beneficial.

“There is an unambiguous case for a substantial reduction in their use alongside the wider adoption of alternative interventions which we know can help to maximise the quality of life for people with dementia and their carers.”

More than 600,000 people in England already have degenerative brain conditions such as Alzheimer’s but the figure is expected to rise to above 1million within a few decades as the population ages.

A Government-commissioned report published in 2009 estimated that 180,000 dementia sufferers are being prescribed anti-psychotic drugs but in as many as 150,000 cases they are unnecessarily being taken, often to keep patients quiet in hospital or nursing homes.

Because the “chemical cosh” drugs are feared to worsen other medical conditions and speed up mental decline, it is estimated that they lead to 1,800 needless deaths – five a day – every year. In addition, they are thought to cause 1,620 strokes, half of which are severe.

The new commissioning pack tells doctors to review all the prescriptions for anti-psychotics by next April; to ensure that they tell hospitals and care homes they work with to look for “therapeutic alternatives”; to publish data on their progress; and to use schemes that pay more to hospitals and other providers if they meet targets.

Sir Ian Carruthers, dementia champion for the NHS, said: “Dementia is one of the greatest challenges society faces today, and it is essential that we get commissioning right so that people can live well in their community, and access more support when they need it.”

http://www.telegraph.co.uk/health/healthnews/8652593/Five-dementia-sufferers-die-every-day-from-chemical-cosh-drugs.html

For more information, read The Psychiatric Abuse of Our Elderly - http://www.cchrint.org/protectelderly/

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At annual convention, psychiatrists collaborate on mental disease mongering to boost profits

admin — Wed, 08 Jun 2011 11:55:07 +0000

Natural News – June 8, 2011

by Monica G. Young

While sipping drinks from coconut shells, psychiatrists from around the world recently met in Honolulu to discuss more ways to capitalize on human behavior and promote drug dependency. The occasion was the annual meeting of the American Psychiatric Association (APA), held in a Hawaiian convention center lined with mental disorder displays and pharmaceutical booths.

“Hot” topics (potential markets for social control and drug pushing) included:

1) Mental health issues during a woman’s reproductive cycle, such as “treating” pregnant women for bipolar – a disorder said to cause unusual shifts in mood and energy levels. In speaking to Medscape News, an APA committee co-chair, Dr. Don Hilty, called this “a really nice-growing area.”

Yet most every woman experiences mood and energy shifts during pregnancy. Despite this, it is not uncommon for pregnant women to be diagnosed as bipolar and prescribed antipsychotics, some of the most powerful drugs on the market. Even the FDA website alerts doctors to “be aware of the effects of antipsychotic medications on newborns when the medications are used during pregnancy.” The site warns of abnormal muscle movements and withdrawal symptoms, and the FDA’s adverse effects reporting program (Medwatch) includes cerebral hemorrhage, heart malformations and death as documented reactions in newborns. Similarly, studies show birth defects and other serious risks for infants whose mothers took antidepressants while pregnant.

2) Childhood disorders were a particularly popular issue at the convention. But they didn’t stop there – prenatal and newborn genetic screening for mental illness has taken on new emphasis in the psychiatric world. “It’s also trying to understand how genetics predict what medications can be used,” stated APA’s Dr. Hilty.

Having already labeled millions of kids “abnormal” and drenched their brains in toxic substances – a multi-billion dollar business – apparently they aren’t satisfied. They aim to brand children as mental patients and destine them for drug-dependency before they’re even born.

The conference even touched upon electroconvulsive shock therapy (ECT) for children – sending electric volts through their heads. That will teach ‘em to shut up and sit still! It will also cause permanent brain damage.

3) ADHD is usually promoted as a childhood disorder but a team of psychiatrists proposed a new definition to make it easier to diagnose (and drug) older teens and adults. They claim people who tend to miss work deadlines and interrupt others deserve this label.

This would surely lead to millions more on daily meds. Who doesn’t know co-workers who miss deadlines or even friends who interrupt you? Not emphasized however is that, per a study published in The Clinical Neuropsychologist, one in four adults seeking an ADHD diagnosis fake it to obtain stimulant drugs.

4) Capitalizing on America’s service men and women was another hot one: diagnosing and drugging the military for post-traumatic distress disorder, depression and anxiety.

Did they mention that 18 U.S. veterans commit suicide daily, largely due to psychiatric drugs? Not likely. As reported by Neev M. Arnell in NaturalNews, “the increasingly high number of deaths among both veterans and active duty soldiers-including suicides, accidental overdose, and lethal drug interactions-have now been linked to the exponential increase in the prescribing of drugs for post traumatic stress disorder, depression and other psychological illnesses.” (http://www.naturalnews.com/032598_v…)

5) Anticipating the “silver tsunami” as the Baby Boomer generation moves into the over-65 bracket, psychiatrists stressed the need for more psychiatric services for the elderly.

Not stressed, if mentioned at all, is the rampant over-use of psychiatric drugs in nursing homes. Elderly patients’ reactions to physical ailments are often squelched with mind-altering drugs. And a recently released government audit shows nearly one in seven elderly nursing home residents are given antipsychotics – nearly all of them dementia patients for whom the drugs can be lethal. Many lawsuits and settlements have revealed that drug companies have falsely promoted these drugs to doctors and nursing homes for years.

6) While not on the “hot” list, another issue that bit was bedbugs. A New York psychiatrist and his colleagues presented a detailed study showing bedbugs can trigger anxiety.

What a remarkable – and potentially profitable – discovery! Gee, with the rise in bedbug infestation in New York City, maybe Bedbug Anxiety should be included in the next edition of the DSM (psychiatry’s diagnostic and billing bible).

Father of psychiatry – the bloodletter

The American Psychiatric Association calls itself “the voice and conscience of modern psychiatry.”

Adorning the convention hall was the APA logo which enshrines Dr. Benjamin Rush (1746-1813) as the father of psychiatry. A very influential doctor, teacher and statesman of his time, Rush propagated his theory that Blacks suffered from an inherited disease called “Negritude.” The only evidence of a cure, he said, was the skin turning white. He warned, “whites should not intermarry with them, for this would tend to infect posterity with the ‘disorder.’” Whites, seeking not to be “infected,” used this fabled disease to justify segregation.

Rush was also a chief proponent of bloodletting as a cure-all for mental and physical illnesses. Widespread in America in those days, he made lots of money at it. One of Rush’s students applied his teachings to a patient who complained of a sore throat: nine pints of blood were removed from the man’s body in twenty-four hours and he died. That patient was George Washington, the first President of the United States.

Sources for this article include:
http://www.medscape.com/viewarticle…

http://www.medscape.com/viewarticle…

http://healthland.time.com/2011/05/…

http://healthland.time.com/2011/04/…

http://www.nytimes.com/2011/05/10/h…

http://www.jstor.org/pss/985399

http://www.websters-online-dictiona…

http://www.cchr.org/cchr-reports/cr…

About the author:
Monica G. Young is a human rights investigator and educational writer with a purpose to expose the truth about the pharmaceutical and psychiatric industries and safeguard human liberty. She encourages non-drug alternative approaches based on healthy lifestyles and human decency. She supports the Citizens Commission on Human Rights and like-minded groups.

Learn more: http://www.naturalnews.com/032638_psychiatrists_disease_mongering.html#ixzz1OgRDAmhA

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Grassley Investigates Drugging of Elderly with Antipsychotics

cchrint — Wed, 01 Jun 2011 17:37:35 +0000

DesMoines Register
May 31, 2011

Sen. Charles Grassley recently sent a letter to the administrator of the U.S. Centers for Medicare and Medicaid Services. He wants some answers after a federal report Grassley requested found many nursing home residents with dementia are given antipsychotic drugs. These drugs are not approved to treat dementia. They can be lethal for those afflicted with it, and Medicare has been paying for them.

Grassley is right to ask questions of the agency. But keeping seniors safe is a responsibility that extends far beyond CMS — from the halls of Congress to state legislatures to nursing home workers in rural Iowa.

Washington

Politicians talk out of both sides of their mouths. They say they want to cut federal spending. They say there should be less government regulation. Then when something goes wrong, they demand federal agencies solve the problems or they take them to task for not doing what they were supposed to do.

Drug safety, nursing home oversight, and ferreting out problems in government programs like Medicare requires staff and resources. That takes money – some of the same money lawmakers propose cutting from the federal budget.

State legislatures

The “cut government but still expect it to keep everyone safe” attitude is prevalent at the state level, too. Shortly after Gov. Terry Branstad took office, one of his appointees cut positions for nursing home inspectors. It underscored a lack of understanding about the important and complicated work of making sure homes meet more than 150 regulatory standards.

In addition to observing care, talking to staff, interviewing residents and other tasks, an inspection team reviews medical records. It is frequently a registered nurse employed by the state who finds problems with medications. Having too few state inspectors puts seniors at risk.

Nursing homes and staff

Improving the quality of life for patients with dementia is difficult — and there are too few drugs approved specifically to do so. Even if doctors are aware of the risks, they may prescribe specific drugs to make patients more comfortable or less agitated. Also, drug companies benefit when more people take their drugs, and they want doctors to prescribe their drugs to, well, as many people as possible. In fact, several drug companies have faced criminal charges for promoting antipsychotic drugs for unapproved uses.

It’s up to nursing home staff and physicians to ensure that drugs prescribed are safe for specific patients.

* * *

Every day about 10,000 Americans become eligible for Medicare. An aging population means more people will be diagnosed with dementia. More will need care in facilities. Everyone — from doctors prescribing drugs to the government paying for them — must do more to keep older people safe.

Read article here: http://www.desmoinesregister.com/article/20110601/OPINION03/106010328/-1/GETPUBLISHED03wp-rss2.php/More-need-help-protect-our-elderly

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Cause for alarm: Antipsychotic drugs for nursing home patients

cchrint — Tue, 31 May 2011 21:17:06 +0000

CNN
By Daniel R. Levinson, Special to CNN
May 31, 2011

Daniel Levinson, inspector general for the OIG in the Department of Health and Human Services.

When a loved one moves into a nursing home, the support of family and friends is particularly important. This is especially true when the nursing home patient has dementia and can’t adequately advocate on his or her own behalf.

A newly released report from my office — the Office of the Inspector General for the Department of Health and Human Services — makes clear just how crucial it is for families to monitor and ask questions about medications that such patients receive. The report found that too often, elderly residents are prescribed antipsychotic drugs in ways that violate government standards for unnecessary drug use.

Frequently, they are prescribed in ways that don’t qualify as medically accepted for Medicare coverage. In addition, the drugs were predominately prescribed for uses that are not approved by the Food and Drug Administration.

But the most potentially troubling finding of the study is this: Researchers found that 88% of the time, these drugs were prescribed for elderly people with dementia.

This is precisely the population that faces an increased risk of death when using this class of drugs, according to the FDA. That’s why the agency puts its strongest safety warning, called a “black box warning” on these antipsychotic drugs, cautioning about the risk of death when taken by elderly people with dementia.

The report didn’t investigate why patients with dementia are prescribed antipsychotic drugs so often. But a series of lawsuits and settlements that my office helped bring about suggests that many pharmaceutical companies have improperly promoted these drugs to doctors and nursing homes for many years.

Another view: In defense of antipsychotics for dementia

The study began a few years ago, when a member of Congress questioned how many nursing home residents received a class of antipsychotic drugs introduced in the 1990s, among them risperidone and olanzapine. These drugs are known as “atypical” or “second generation” antipsychotics. They replaced the antipsychotic drugs introduced in the 1950s and 1960s to treat schizophrenia — and, incidentially, are far costlier.

The report found about 305,000 nursing home residents (about 14%) had Medicare claims for atypical antipsychotic drugs. Of these, about one in five residents was prescribed these antipsychotics in a way that violated government standards for their use. For example, residents were on a drug for too long, or at too high a dose.

Another finding: A little more than half the antipsychotic drug claims for which Medicare paid should not have been covered. Why? The claimed drugs were not used for medically accepted reasons or there were no records the drugs were actually provided.

To be clear: Most physicians and nursing homes dispense antipsychotic drugs with the best interests of patients in mind. Physicians can use their medical judgment to prescribe drugs for uses unapproved by the FDA, and also to patients for whom the boxed warning applies. Ideally, however, doctors who prescribe in such ways first determine that the benefits outweigh the risks.

Yet it remains a concern that so many elderly nursing home residents with dementia are prescribed antipsychotics. And, unfortunately, examples abound of companies’ improper promotion of these drugs.

Government investigations of Bristol-Myers Squibb, AstraZeneca and Pfizer found that they improperly promoted their antipsychotic drugs for unapproved uses.

Federal prosecution is pending against Johnson & Johnson for allegedly paying millions of dollars in kickbacks to induce Omnicare, the nation’s largest long-term care pharmacy, to recommend the use of Risperdal in treating nursing home patients, many of whom had dementia.

And Eli Lilly pleaded guilty to criminal charges associated with illegally marketing its drug Zyprexa, including to doctors who treat elderly nursing home patients.

Pharmaceutical companies have paid billions to resolve civil and criminal liabilities under federal health and safety laws. But money can’t adequately compensate for corporate campaigns that could put vulnerable, elderly patients at risk.

How do we solve this problem? There’s plenty to do.

Family members of nursing home residents must learn about their loved ones’ medications, the reasons for their use, proper dosages and possible side effects.

Nursing homes and pharmacies that serve the elderly must keep the best interests of the patient in mind when dispensing pharmaceuticals and not base the decision on the improper influence of drug companies.

Doctors, too, should rely on their best medical judgments and engage in an especially careful analysis when prescribing drugs for off-label use.

Government must combat illegal off-label promotion of these powerful and potentially lethal drugs and uphold nursing home safety standards.

And drug companies should follow the laws, and refrain from promoting drugs for unapproved uses — or paying kickbacks to influence doctors and institutions. About 46 million people are enrolled in Medicare. That will only grow as the huge baby boomer population retires. We cannot afford to leave unaddressed the urgent problem of antipsychotic drug use among elderly nursing home residents.

The opinions in this commentary are solely those of Daniel Levinson.

Read article here: http://www.cnn.com/2011/OPINION/05/31/levinson.nursing.home.drugs/

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Antipsychotic Drugs Called Hazardous for the Elderly

cchrint — Tue, 10 May 2011 03:57:23 +0000

The New York Times
By Gardiner Harris
May 9, 2011

Nearly one in seven elderly nursing home residents, nearly all of them with dementia, are given powerful atypical antipsychotic drugs even though the medicines increase the risks of death and are not approved for such treatments, a government audit found.

More than half of the antipsychotics paid for by the federal Medicare program in the first half of 2007 were “erroneous,” the audit found, costing the program $116 million for those six months.

“Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” Daniel R. Levinson, inspector general of the Department of Health and Human Services, wrote in announcing the audit results.

Mr. Levinson noted that such drugs — which include Risperdal, Zyprexa, Seroquel, Abilify and Geodon — are “potentially lethal” to many of the patients getting them and that some drug manufacturers illegally marketed their medicines for these uses “putting profits before safety.”

The audit is an unusual assessment by the government of whether doctors are treating Medicare patients appropriately in nursing homes. Mr. Levinson suggested that the government should collect information on the diagnoses given Medicare patients so that the government can assess whether the drugs prescribed to them are appropriate.

While common in the private sector, such basic oversight is unheard of in the Medicare program and would almost certainly be opposed by doctors’ groups and many in Congress who view government intrusions into the doctor-patient relationship as inappropriate. In response to the audit, the Centers for Medicare and Medicaid Services said that some of the inappropriate use of antipsychotics in elderly nursing home patients is a result of drug makers’ paying kickbacks to nursing homes to increase prescriptions for the medicines.

Omnicare Inc., a pharmacy chain for nursing homes, paid $98 million in November 2009 to settle accusations that it received kickbacks from Johnson & Johnson and other drug makers for antipsychotic prescriptions.

Medicare officials said that diagnosis information is not generally included with prescriptions so the government cannot assess in real time whether prescription payments are appropriate.

While the Food and Drug Administration has warned doctors that using antipsychotic drugs in elderly patients with dementia increases their risks of death, doctors continue the practice because they have few other good choices, said Dr. Daniel J. Carlat, editor in chief of The Carlat Psychiatry Report, a medical education newsletter for psychiatrists.

“Doctors want to maximize quality of life by treating the patient’s agitation even if that means the patient will die a bit sooner,” Dr. Carlat said.

The government auditors found that of the 2.1 million elderly patients in nursing homes during the first six months of 2007, 304,983 had at least one Medicare claim for an antipsychotic medicine. Nursing home residents received 20 percent of the 8.5 million claims for antipsychotic medicines for all Medicare beneficiaries at a cost of $309 million during those six months.

The auditors found that 83 percent of antipsychotic prescriptions for elderly nursing home residents were for uses not approved by federal drug regulators, and 88 percent were to treat patients with dementia — for whom the drugs can be lethal.

“These results are alarming,” said Senator Charles E. Grassley, Republican of Iowa, who asked for the audit. “Medicare officials need to pay attention.”

Federal rules require that any drugs that are paid for by the government be given only for uses that are approved either by the government or one of three independent drug usage encyclopedias. Auditors found that 51 percent, or 726,000 of 1.4 million claims, for antipsychotic medicines did not meet this criterion and were thus paid for by the government improperly.

Government rules also ban drugs that are used in excessive doses or duration, even if patients are found to have a condition for which the drug is appropriate. Auditors found that 22 percent, or 317,971 of 1.4 million claims, for antipsychotic medicines failed this standard.

Read article here: http://www.nytimes.com/2011/05/10/health/policy/10drug.html?_r=2

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All Classes of Psychiatric Drugs Found Equally Dangerous for Nursing Home Residents

admin — Mon, 28 Mar 2011 18:55:02 +0000

MedicalNews Today March 28, 2011

Conventional antipsychotics, antidepressants and benzodiazepines often administered to nursing home residents are no safer than atypical antipsychotics and may carry increased risks, according to an article in CMAJ (Canadian Medical Association Journal).

Psychotropic medications are often used to manage behavioral symptoms in seniors, particularly people with dementing illnesses, with up to two-thirds of dementia patients in nursing homes prescribed these medications. However, the effectiveness of these drugs in this indication is unclear and important safety concerns exist, especially related to antipsychotics.

Psychotropic or psychoactive medications act upon the central nervous system and are prescribed for the management of mental and emotional disorders. They include, amongst others, first and second generation antipsychotics (also known as conventional and atypical antipsychotics), antidepressants, benzodiazepines and other sedatives. Despite their widespread use, none of these treatments has been approved by the FDA or Health Canada for the management of behavioral symptoms associated with dementia.

A team of researchers from Brigham and Women’s Hospital in Boston, Massachusetts, undertook the study to evaluate the comparative safety of various psychotropic medication classes, focusing on patients in nursing homes because of the extensive use of these drugs in this setting and the complexity of these patients’ illnesses. The study cohort included all BC residents admitted to a nursing home between Jan. 1, 1996 and March 31, 2006 and who received a psychotropic drug within 90 days of admission.

Of the 10 900 patients in the study, 1942 received an atypical antipsychotic, 1902 a conventional antipsychotic, 2169 an antidepressant and 4887 a benzodiazepine. Rigorous methodological approaches were applied to ensure this non-randomized study was not affected by the selective prescribing that tends to occur in routine care.

“In 10 900 older adults newly admitted to nursing homes in BC who began taking psychotropic medications, we observed risks of death that were higher among those who initiated conventional antipsychotics, antidepressants and benzodiazepines. We also observed risks of femur fracture that were higher with conventional antipsychotics, antidepressants and benzodiazepines used for anxiety, all compared with atypical antipsychotics. No clinically meaningful differences were observed for risk of pneumonia or heart failure, except possibly a lower risk of pneumonia and a higher risk of heart failure with benzodiazepines,” state the authors.

They conclude that a large randomized trial is required to confirm their findings but that clinicians should weigh the increased risks against potential benefits when considering prescribing these medications for their patients in nursing homes.

http://www.medicalnewstoday.com/articles/220129.php

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CCHR International » dementia

Are Nursing Homes Over-Drugging Their Residents?

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