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LeadingAge Contributes to Senate Aging Committee's Analysis of Antipsychotic Drugs in Nursing Homes

by Published On: Dec 02, 2011

On  Nov. 30, I testified on LeadingAge's behalf at a U.S. Senate Special Committee on Aging hearing regarding the inappropriate use of antipsychotic drugs in nursing homes.

Interest and action about this issue has grown over the past year. In May, Office of the Inspector General (OIG) released report strongly opposing the widespread use of the drugs. OIG researchers found that 14% of elderly nuring home residents where on antipsychotics drugs and that 88% of these were for non-approved indications, including managing  dementia-related behavior issues.

These findings are shocking in light of the Food and Drug Administration (FDA) 2005 black-box warning that linked the use of these drugs in the elderly population with dementia to an increased risk of cardiovascular events and death.

Also, former Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Don Berwick brought together a group of stakeholdesr, including LeadingAge, on Oct. 26 to readdress the importance of this issue and requested that each of the organizations provide a written response.

The hearing was the next step in this investiation. The other hearing witnesses included:

  • Daniel Levinson, OIG
  • Patrick Conway, M.D., CMS
  • Jonathan Evans, MD, American Medical Directors Association
  • Tom Hlavacek, the Alzheimer's Association of Southeast Wisconsin
  • Toby Edelman, Center for Medicare Advocacy

While we all provide different perspectives on the issue in our testimonies, we all believe that inappropriate use of antipsychotic drugs is harmful and must be corrected. Dr. Conway stated that there will be increased survey focus on this issue related to the regulations related to Avoiding Unnecessary Drugs (F-329).

The goal of my testimony was to better clarify what constitutes an unnecessary drug and outlining 5 steps prescribers should take before considering giving a patient an antipsychotic drug.  I also shared the cautionary note that this is not merely an issue of a single class of drugs nor is it an issue limited to nursing homes. Three-quarters antipsychotic drug use among the eldery occurs outside the nursing home. 

This is a challenge for the entire health care system to better understand non-pharmacologic approaches to dementia care, to look at opportunities to replicate programs in a large-scale way and to provide meaningful education and tools for all staff to improve patient-centered care for people with dementia. 

I also had the opportunity to acknowledge LeadingAge recently formed to learn what innovative  dementia care models our members are developing and shared specifically the two remarkable programs at Eliza Jennings in Cleveland, OH, and Ecumen "Awakenings" in Minnesota.  

I closed with the challenge that I believe that nursing homes can, and should be, the centers of excellence for the care of people with dementia and serve as a learning laboratory for other settings. 

This is a a goal I believe all LeadingAge members will acheive.

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