Despite FDA warnings and CMS measures, antipsychotic use rises and electroshock continues on vulnerable seniors. Intensive oversight is needed, and electroshock should be banned.
Jan Eastgate
President, CCHR International
November 13, 2026
A federal watchdog report has found that nursing homes continue to use antipsychotics as chemical restraints, sometimes without first attempting required non-drug interventions. National data showed antipsychotic use among adults aged 65 and older increased nearly 52% between 2015 and 2024, while long-term use increased almost 65%.[1] Much greater oversight is needed, not only of the elderly being drugged, but also of those given electroshock treatment, a practice that should be banned.
A Health and Human Services (HHS) report notes the amount of use of antipsychotic drugs among nursing home residents remains concerning despite efforts to decrease their use over the last decade. These powerful drugs are known to have severe side effects, particularly among elderly individuals with dementia. In 2008, the Food and Drug Administration (FDA) issued a boxed warning against the use of all antipsychotics among elderly individuals with dementia because of the increased risk of death.[2] Studies also link newer antipsychotics in older adults with dementia to sharply increased risks of stroke, heart failure and accelerated cognitive decline.There is also a heightened risk of bone fractures related to falls.[3]
HHS Office of Inspector General (OIG) reported that these drugs can have a sedative effect, raising concerns that nursing homes may use them to control residents’ behavior—to manage their behavior for the benefit of staff. The agency found that some medical directors failed to prevent inappropriate use of them; nursing home pharmacists failed to identify medical concerns and did not recommend dose reductions. Inadequate nursing home policies and procedures undermined safeguards meant to protect residents.[4] This is despite the Centers for Medicare & Medicaid Services (CMS) taking steps to discourage the use of these drugs by, for example, developing publicly reported quality measures related to the use of antipsychotics among nursing home residents.[5]
The human cost is clear. Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, notes the poor outcomes: “Instead of getting to the root problem and addressing the problem, we’re quieting them down. And then that’s what leads to significant problems with their health and well-being.”[6]
Nearly every person diagnosed with dementia — up to an estimated 97% — will eventually experience changes in mood, perception or behavior.[7] This puts them at risk of being prescribed psychotropic drugs and electroshock treatment—the passage of up to 460 volts of electricity through the brain, which induces a grand mal seizure.
According to The New York Times, elderly persons are given electroshock when they’ve been prescribed “so many other drugs that they cannot safely add a powerful psychiatric drug.”[8] A psychiatrist writing in Ethical Human Psychology and Psychiatry warned that “ECT is especially devastating to the vulnerable brain and body of the elderly…. As would be predicted based on the fragility of the older brain, ECT causes more severe brain dysfunction in the elderly.”[9] He also said that ECT has been on the increase because “there’s a market that’s been exploited” with elderly women on Medicare.[10]
Combine ECT and antipsychotics, and it’s a time bomb waiting to go off. As The New York Times further reported, “Antipsychotic drugs—which for decades have faced criticism as ‘chemical straitjackets’—are dangerous for older people with dementia, nearly doubling their chance of death from heart problems, infections, falls and other ailments.”[11]
Between 2012 and 2014, Medicare, which primarily serves those aged over 65, paid $29.6 million to physicians (not including anesthesiologists who render the patient unconscious before treatment) for administering and monitoring ECT. More than 125,500 ECT treatments were delivered in 2014.[12] Medicare listed 20,436 beneficiaries given electroshock in 2018. Nearly 116,000 ECT treatments were delivered. Between 2016 and 2018, the program paid $31 million to physicians (also not including anesthesiologists) for administering and monitoring ECT.[13]
A study published in Clinical Neuropsychologist found that in 62 non-demented elderly depressed patients (compared with healthy elderly controls), neuropsychological testing within one week after ECT showed that 40% had a significant individual-level decline in functioning. The most common decline was in delayed verbal anterograde memory; 11% showed retrograde amnesia for public facts.[14]
A systematic review and meta-analysis published in the British Journal of Psychiatry revealed that across nine studies (432 patients), ECT produced larger autobiographical memory loss than controls. The authors concluded that ECT causes autobiographical memory loss that is not regained.[15]
Autopsies should be mandatory where the elderly die while undergoing or shortly after receiving ECT to determine what effects it may have had on their hearts. In a 1993 Brown University study of patients 80 and older, 27% of shock patients were dead within one year compared to 4% of a similar group not treated with ECT. In two years, 46% of shocked patients were dead vs. 10% who had not received ECT.[16]
The FDA also reports that potentially significant adverse events associated with ECT include “cardiac ischemia [insufficient blood supply and oxygen to the heart], cardiac arrhythmias [abnormal heart rhythm], prolonged apnea [breathing stops and starts] and even death.”[17]
Giving electroshock to treat “agitation in Alzheimer’s disease” and “other types of dementia” is not an indication approved by the FDA, but as the FDA does not regulate medicine, psychiatrists can administer the brain-damaging practice anyway they choose. ECT can cause confusion and memory loss—already found in dementia and, therefore, these could be worsened.[18]
No one would allow a doctor to club our frail elderly to change their behavior, but this is what is happening across the country using electroshock in the name of mental health care.
Non-drug approaches range from personalized music playlists and walking programs to reminiscence therapy using old photographs and household objects.
The cumulative picture is one of institutionalization that too often relies on drugs, ECT, and restraints rather than addressing root causes. This is the legacy of the widespread introduction of psychiatric treatment into the care of the elderly and requires intense oversight, an end to forced psychiatric treatment, and the adoption of safer alternatives.
[1] “Meds Are Often the Go-to for Dementia Patients. Is There a Better Way?” Knowable Magazine, 26 Oct. 2026, https://knowablemagazine.org/content/article/health-disease/2026/can-non-drug-approaches-ease-lives-dementia-patients
[2] “Series: In-Depth Review of Nursing Home Citations Related to the Use of Antipsychotic Drugs,” HHS, 15 Feb. 2023, modified 16 Mar. 2026, https://oig.hhs.gov/reports/work-plan/browse-work-plan-projects/srs-e-26-006/
[3] Pearl L H Mok, et al., “Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study,” The BMJ, 17 Apr. 2024, https://www.bmj.com/content/385/bmj-2023-076268; Adam H. Dyer, et al., “Long-term antipsychotic use and cognitive decline in community-dwelling older adults with mild–moderate Alzheimer disease: Data from NILVAD,” International Journal of Geriatric Psychiatry, 26 June 2021, https://onlinelibrary.wiley.com/doi/full/10.1002/gps.5591
[4] “Nursing Homes’ Inappropriate Use of Antipsychotic Drugs Poses a Risk to Residents,” HHS OIG, 16 Mar. 2026, https://oig.hhs.gov/reports/all/2026/nursing-homes-inappropriate-use-of-antipsychotic-drugs-poses-a-risk-to-residents/
[5] “Series: In-Depth Review of Nursing Home Citations Related to the Use of Antipsychotic Drugs,” HHS, 15 Feb. 2023, modified 16 Mar. 2026, https://oig.hhs.gov/reports/work-plan/browse-work-plan-projects/srs-e-26-006/
[6] “Meds Are Often the Go-to for Dementia Patients. Is There a Better Way?” Knowable Magazine, 26 Oct. 2026, https://knowablemagazine.org/content/article/health-disease/2026/can-non-drug-approaches-ease-lives-dementia-patients
[7] “Meds Are Often the Go-to for Dementia Patients. Is There a Better Way?” Knowable Magazine, 26 Oct. 2026, https://knowablemagazine.org/content/article/health-disease/2026/can-non-drug-approaches-ease-lives-dementia-patients
[8] https://www.cchrint.org/2021/05/17/cchr-urges-mental-health-month-oversight-of-elderly-being-electroshocked/; Duff Wilson, “F.D.A. Is Studying the Risk of Electroshock Devices,” The New York Times, 23 Jan. 2011, http://www.nytimes.com/2011/01/24/business/24shock.html
[9] “The FDA Should Test the Safety of ECT Machines,” Ethical Human Psychology and Psychiatry, Volume 12, Number 2, 2010, http://www.ingentaconnect.com/content/springer/ehpp/2010/00000012/00000002/art00007?crawler=true; https://www.cchrint.org/2021/05/17/cchr-urges-mental-health-month-oversight-of-elderly-being-electroshocked/
[10] https://www.cchrint.org/2017/01/03/electroshocking-elderly-cchr-questions-potential-lethal-effects/; Duff Wilson, “F.D.A. Is Studying the Risk of Electroshock Devices,” The New York Times, 23 Jan. 2011, http://www.nytimes.com/2011/01/24/business/24shock.html.
[11] https://www.cchrint.org/2021/09/20/cchr-urges-greater-govt-oversight-of-elderly-chemically-restrained-and-shocked/; Katie Thomas, Robert Gebeloff and Jessica Silver-Greenberg “Phony Diagnoses Hide High Rates of Drugging at Nursing Homes,” The New York Times, 16 Sept. 2021, https://www.nytimes.com/2021/09/11/health/nursing-homes-schizophrenia-antipsychotics.html
[12] https://www.cchrint.org/2017/01/03/electroshocking-elderly-cchr-questions-potential-lethal-effects/, citing: Medicare Provider Utilization and Payment Data: Physician and Other Supplier, Centers for Medicare and Medicaid Services, CY 2012 through CY 2014, https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/medicare-provider-charge-data/physician-and-other-supplier.html
[13] https://www.cchrint.org/2021/09/20/cchr-urges-greater-govt-oversight-of-elderly-chemically-restrained-and-shocked/; Medicare Provider Utilization and Payment Data: Physician and Other Supplier, Centers for Medicare and Medicaid Services, CY 2016 through CY 2018, https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/medicare-provider-charge-data/physician-and-other-supplier.html
[14] Gro Strømnes Dybedal, et al., “Cognitive Side-effects of Electroconvulsive Therapy in Elderly Depressed Patients,” The Clinical Neuropsychologist, Vol. 28, 2014, https://www.tandfonline.com/doi/full/10.1080/13854046.2014.958536
[15] André Beyer Mathiassen, et al. “Autobiographical memory after electroconvulsive therapy: systematic review and meta-analysis,” The British Journal of Psychiatry, Cambridge Press, 13 May 2025, https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/autobiographical-memory-after-electroconvulsive-therapy-systematic-review-and-metaanalysis/8F694868E2767C11F75DBA2C341C21AF
[16] https://www.cchrint.org/2017/01/03/electroshocking-elderly-cchr-questions-potential-lethal-effects/; “Patients often aren’t informed of full danger,” USA Today, http://usatoday30.usatoday.com/life/health/lhs195.htm
[17] https://www.cchrint.org/2017/01/03/electroshocking-elderly-cchr-questions-potential-lethal-effects/; “FDA Executive Summary Prepared for the January 27-28, 2011 meeting of the Neurological Devices Panel Meeting to Discuss the Classification of Electroconvulsive Therapy Devices (ECT),” p.6
[18] https://www.cchrint.org/2021/05/17/cchr-urges-mental-health-month-oversight-of-elderly-being-electroshocked/; Sara Youngblood Gregory, “What causes agitation in Alzheimer’s disease?” Mayo Clinic, 26 Aug. 2026, https://mcpress.mayoclinic.org/healthy-aging/what-causes-agitation-in-alzheimers-disease/; “Other types of dementia,” Alzheimer Society of Canada, https://alzheimer.ca/en/about-dementia/other-types-dementia; Electronic Code of Federal Regulations (e-CFR) Title 21—Food and Drugs, CHAPTER I—FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES, SUBCHAPTER H—MEDICAL DEVICES PART 882—NEUROLOGICAL DEVICES, Subpart F—Neurological Therapeutic Devices, § 882.5940 Electroconvulsive therapy device, https://www.law.cornell.edu/cfr/text/21/882.5940
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