The Free Press, Mankato, MN

State, national news

July 16, 2013

New trend in nursing home care -- fewer drugs, more personalized attention


Nationwide, 25 percent of nursing home patients are on antipsychotics, according to a study by the federal Centers for Medicare & Medicaid Services. The Centers for Medicare & Medicaid Services has set a directive that facilities should reduce their use of the medications by 15 percent, but few homes have complied.

That’s because nursing home administrators say there is no easy fix. Weaning patients off drugs is complicated. And keeping them off requires facilities to completely rethink their programs and staffing at a time when many are facing cuts in federal and state funding.

“Treating these patients isn’t an exact science, and we may have to introduce new medications while discontinuing others — it’s difficult to find that balance,” said Matthew Russo, administrator of the Armenian Nursing Home and Rehabilitation Center in Emerson, N.J., where 23.9 percent of the patients were on the drugs in 2012.

Federal health officials say getting elderly patients off antipsychotic drugs is crucial because such medications pose a risk of serious complications when taken by those who aren’t suffering from a mental illness.

“The elderly can be affected with a higher incidence of stroke, cardiac and respiratory problems and even death,” said Dr. Diego Coira, chairman of the department of psychiatry and behavior medicine at Hackensack University Medical Center.

Research has shown that the risk of death doubles when these drugs are given to patients with dementia. The drugs also can render elderly patients who don’t need them immobile, leading to inadequate food and liquid intake, incontinence, infections and bedsores, experts said.

“These medications do have a place, Coira said, “but they are overused.”

Pharmaceutical companies have encouraged the use of these medications in nursing homes, advocates said. In fact, 36 states filed suit against Johnson & Johnson contending the company improperly marketed the schizophrenia drug Risperdal for the treatment of Alzheimer’s disease and dementia. The company also was accused of providing lucrative agreements to physicians who prescribed the drug off-label.

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