Antipsychotics: Still a Problem

Throughout the U.S., more than one in five nursing home residents receive the power and mind-altering antipsychotic drugs. That is more than ten times the rate of the general population, though the conditions treated by these drugs do not increase with age.

In Mississippi, that goes up to one in four residents. According to federal data, Mississippi is among the top five states in the U.S. for administering antipsychotic drugs in nursing homes. 

Dr. Michael Wasserman, a geriatrician and former CEO of the largest nursing home chain in California, says, “The national average tells us that there are still a large number of older residents who are inappropriately being prescribed antipsychotics,” and “The Mississippi numbers can not rationally be explained,”

Lisa Smith, Mississippi’s long-term care ombudsman, declined to comment on this story. 

Hank Rainer, a certified social worker in the Mississippi nursing home industry for 40 years, said that the problem is two-fold. Nursing homes are not equipped to care for large populations of mentally ill adults, and many misdiagnose behavioral symptoms of dementia as psychosis. 

A new study reveals the need for standardized prescribing practices regarding benzodiazepines and antipsychotics. These two drugs are routinely prescribed for symptom management in hospice-level care.

Lauren B. Gerlach, D.O., and colleagues noted that there is only a small amount of high-quality evidence that guides their use and that the lack of information reflects the wide range of prescribing practices. The 2017 analysis included 1.4 million hospice residents, ages 65 and older, who represented over 4,200 hospice agencies. Researchers examined the agency-level rate of enrollees with prescription fills of benzodiazepine and antipsychotics. Researchers also compared prescription rates through patient and agency characteristics, like profit status, size, and region. Results showed that the highest prescribing hospice agencies were for-profit and larger hospices, and these had a smaller proportion of minority populations.

Gerlach, University of Michigan, noticed no change in the characteristic variation of the hospice patients. Therefore, the prescription of these drugs is based on other factors rather than the patient’s clinical needs. Gerlach noted, “There appears to be significant variation in what is considered clinically appropriate use in the U.S. hospice population,”. Agency-level characteristics are important as they develop and focus on different interventions to promote appropriate prescription. It is “critical to explore the extent to which individual clinicians may contribute to this variation.” Gerlach stated.