Anti-psychotics in ALFs

Anti-psychotics medications are dangerous for elderly residents. The risk of harm outweighs the medical benefits. The FDA placed a black box warning on administering anti-psychotics for off-label use. The nursing home industry often used anti-psychotics as a chemical restraint to compensate for unsafe staffing.

CMS warned the industry to reduce unnecessary and dangerous antipsychotic medication prescribing in long-term care facilities. CMS was successful. The National Partnership to Improve Dementia Care in Nursing Homes reported a 30% decrease in antipsychotics prescriptions among long-stay nursing home residents with Alzheimer’s disease and related dementias.

However, the Journal of the American Geriatrics Society published a new study showing prescriptions to assisted living residents with dementia has increased.  There was a “slight increase” in mood stabilizer and / or anticonvulsant medication prescribing in the assisted living population, mainly for gabapentin (known by brand names such as Gralise, Horizant and Neurontin).

The known dangers of antipsychotic and other psychotropic medication use in people with Alzheimer’s and related dementias occur regardless of setting. Eliminating or reducing off-label antipsychotics in long-term care should be the goal.