GAO: Dementia patients receiving harmful antipsychotics

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A government watchdog report found that one-third of American nursing-home residents diagnosed with dementia have received antipsychotic medications, like Abilify and Risperdal, and 14% of Medicare Part D dementia patients who have not spent time in nursing homes have also been given these medications to treat behaviors such as aggression, which can be associated with the disease.

The Government Accountability Office is concerned that both older “typical” antipsychotics like Haldol and Loxitane and “atypical” antipsychotics like Abilify have been associated with an increased risk of hypotension, sedation, falls and death among dementia patients. The drugs are not indicated for dementia patients, but the GAO researchers noted that physicians are not barred from prescribing them for off-label uses.

The government researchers found that men were more likely to receive antipsychotics than women and that internists, family medicine physicians, psychiatrists and neurologists wrote 82% of antipsychotic medications for Medicare Part D patients who had dementia.

They also found higher prescription rates at nursing homes with the smallest staffs. One expert told the GAO that small-staffed nursing homes “may not have enough activities and oversight for the patients which in turn may make the nursing home residents susceptible to higher antipsychotic drug use.” Toby Edelman, a senior policy attorney for the Center for Medicare Advocacy, told AARP something similar in a 2014 interview, saying nursing homes use antipsychotics as “chemical restraints.”

While the GAO concedes that doctors are not prohibited from using antipsychotics for off-label uses, materials advocating such use have come under scrutiny. Johnson & Johnson in 2013 agreed to pay $2.2 billion to settle allegations made by the Department of Justice over its marketing of Risperdal, Invega and heart drug Natrecor. The settlement covered a variety of allegations including marketing Risperdal for off-label uses the federal government does not cover, which made the federal health claims fraudulent.

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