Psychiatric or psychotropic medications are commonly prescribed to seniors to manage symptoms and behaviors. There are well-known negative and sometimes dangerous side effects associated with these drugs and the elderly are far more vulnerable to experience them. Seniors living in care communities are more likely to be prescribed psychiatric medications, and many times, they are administered more than one type of drug. Some experts report that over half of seniors in skilled nursing facilities are on one or more psychiatric medications.
Antipsychotic Drugs and Ethical Dilemmas
Some residents are administered daily antipsychotic drug doses that exceed recommended levels. Antipsychotics are prescribed many times for residents who are cognitively impaired due to conditions like dementia and Alzheimer’s disease. While they are used to help manage behavioral and psychiatric symptoms, they come with potentially dangerous side effects.
One of the most common effects of these types of medications is sedation, and there are ethical concerns about this. In this way, antipsychotics may be viewed as a chemical restraint, one that controls the resident. The use of these drugs can lead to accidents and falls, impaired cognition, restlessness, constipation, cardiovascular problems and poor quality of life.
Off-Label Use of Antipsychotics
Antipsychotics were approved by the FDA for use only among residents diagnosed with schizophrenia. The use of these drugs for other conditions such as psychosis or agitation due to dementia, is off-label. Importantly, the off-label use of drugs is not prohibited and may actually be necessary to treat severe behavioral disorders for which there are no approved drugs whatsoever. This creates quite an ethical dilemma as well – prescribe off-label medications or don’t use them at all. Off-label use reflects the fact that there is not enough evidence of the efficacy of these drugs in specific conditions based on randomized controlled trials.
Clinical Leadership’s Role in Reducing Antipsychotic Drugs
There has been a push for several years to reduce the amount of psychiatric medications prescribed to seniors in care centers, and in particular, to reduce or eliminate antipsychotics as much as possible. Anyone who has worked in skilled nursing knows this is no easy or simple task. Despite this, healthcare professionals do their best to provide high quality care while minimizing or discontinuing antipsychotic use among their residents. Clinical leaders across the country keep this goal on their radar at all times, and will continue to follow The Centers for Medicare and Medicaid Services (CMS) goals for reducing antipsychotics in senior care.
Clinical leaders need to keep a constant eye on the medical necessity of antipsychotic drugs and make a decision determining if they will improve quality of life or result in further impairment. This is especially true for residents diagnosed with dementia-related disorders. Care should be person-centered, interdisciplinary and comprehensive.
CMS wants to see the use of person-centered interventions over the use of antipsychotic medications, and leadership should stay up to date with these goals. Each care community should have a systematic approach to evaluating each resident and identify person-centered means of providing good clinical care improving their quality of life.
Final Thoughts on Antipsychotic Drugs in Senior Care
The elderly population is growing at a fast pace, and the need for skilled nursing care will increase over the next few decades. With this boom in the senior population, comes an increase in the number of seniors who will experience cognitive impairment due to Alzheimer’s, Lewy Body Dementia, Frontotemporal Dementia and others. Until there is a medication developed specifically for dementia-associated symptoms, the use of antipsychotic medication may remain one of the only options.
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