Are senior citizens being overmedicated? – The Chart - CNN.com Blogs

Strong, antipsychotic drugs are being prescribed more often to senior citizens in U.S. nursing homes, setting off a debate about whether it's the right treatment for the elderly suffering from dementia.

Daniel Levinson, inspector general for the Department of Health and Human Services, believes this increase - detailed in a recent study by his office - is a cause for alarm.  "The report found that too often, elderly residents are prescribed antipsychotic drugs in ways that violate government standards for unnecessary drug use," he wrote in a commentary for CNN.com.

Psychiatrist Daniel Carlat disagrees, saying the study Levinson cites is a "blizzard of statistics" that doesn't tell the entire story.  "When these drugs are successful, they soothe the inner turmoil that makes life intolerable for these patients, improving their quality of life dramatically," Carlat wrote in his commentary for CNN.com.

via thechart.blogs.cnn.com

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U.S. Sees Slowdown in Spending on Mental Health

The amount of money spent on psychiatric drugs in the United States continues to grow but at a much slower rate than in previous years, a new federal government study has found.

From 2004 to 2005, spending on psychiatric drugs rose 5.6 percent, compared with an increase of 27.3 percent between 1999 and 2000, according to the Substance Abuse and Mental Health Services Administration.

The agency's analysis of health-care costs from 1986 to 2005, the latest year comparable data is available, also found that spending on behavioral health accounts for a decreasing portion of overall health-care costs.

Of the $1.85 trillion spent on all health-care services in the United States in 2005, behavioral health spending accounted for 7.3 percent ($135 billion). During the 20 years analyzed in the study, spending for mental health and substance abuse health care grew more slowly than all other health spending: 4.8 percent a year for substance abuse; 6.9 percent a year for mental health and 7.9 percent a year for all health-care services.

From 2002 to 2005, spending rose 5 percent for substance abuse, 6.4 percent for mental health and 7.3 percent for all health-care services, according to the study, published Feb. 3 in Health Affairs.

Among the other findings:

• Spending on addiction medications grew from $10 million in 1992 to $141 million in 2005. However, the $141 million represents only 0.6 percent of the $22 billion spent on substance abuse treatment in 2005.
• In 2005, behavioral health treatment accounted for 4.8 percent of private health insurance spending, compared with 11.5 percent of total Medicaid spending. The agency said that the figures can be used as a baseline for evaluating the effect of the Mental Health Parity and Addictions Equity Act and the Affordable Care Act.
• Unlike overall health spending, the largest portion of behavioral health spending is publicly funded. In 2005, public money paid for 79 percent of spending on substance abuse treatment and 58 percent of mental health services spending, compared with 46 percent of all health spending.

via womenshealth.gov

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Mass. aims to cut drug overuse for dementia - The Boston Globe

State regulators and the Massachusetts nursing home industry are launching a campaign today to reduce the inappropriate use of antipsychotic medications for residents with dementia — a practice that endangers lives and is more common here than in most other states.

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During the next year, a team of specialists will identify nursing homes with successful methods for avoiding overuse of antipsychotics and determine which homes need help cutting back. Nursing home staff will be taught how to deal with aggressive and difficult behaviors, often displayed by dementia patients, without resorting to antipsychotics to sedate them.

In 2009, 22 percent of Massachusetts nursing home residents who received antipsychotic medications did not have a diagnosis for which the drugs were recommended — the 12th highest rate of inappropriate antipsychotic use in the nation, the Globe re ported earlier this year.

Twice in the past five years, federal regulators have issued nationwide alerts about troubling and sometimes fatal side effects when antipsychotics are taken by people with dementia, often Alzheimer’s patients.

Specialists say that understaffing sometimes prompts overuse of these medications to help control dementia patients’ behavior, but that inappropriate use can also be traced to lack of training in alternative approaches.

“There is a knowledge gap between the front-line workers — the nurses — and the black-box warnings on these medications,’’ said Laurie Herndon, a geriatric nurse practitioner who is leading the initiative for Massachusetts Senior Care, the trade group representing the state’s 430 nursing homes. A black-box warning is the most serious type of caution used in prescription drug labeling.

“We wanted to avoid talking at them, and instead provide educational material they can use,’’ Herndon said.

Campaign details will be unveiled at the association’s annual meeting today in Worcester, which is expected to draw about 900 people.

Alice Bonner, the state’s top nursing home regulator, said she appointed a task force to study the overuse of antipsychotics in nursing homes and develop alternative approaches after the Globe highlighted the problem in Massachusetts earlier this year. The task force includes nursing home physicians, nurses, social workers, and pharmacists, along with elder advocates, researchers, and state surveyors who monitor the quality of the facilities.

Bonner, director of the Bureau of Health Care Safety and Quality in the Department of Public Health, said the state, given its budget problems, does not have new resources to devote to the campaign, but is working with legislators and the Patrick administration to get new funding in the next state budget. The trade association intends to apply for grants from nonprofit groups to fund the initiative.

“No one is going to plunk a whole lot of money in our laps,’’ Herndon said, “but that shouldn’t stop us.’’

Bonner said that the task force has already identified low-cost approaches used by some nursing homes. One approach involves more careful screening of patients when they are admitted, which includes gathering more detailed information from families about the patient’s personality before the onset of illness. This, Bonner said, helps staffers tailor care and activities to each patient.

“They get a good sense of who a person was before they began to suffer with dementia, what kinds of things they like to do, and what kinds of things their family can tell us makes them calm or gets them engaged,’’ Bonner said.

“When you see a nursing home with a low rate of antipsychotics, very often you will see these programs,’’ she said.

Bonner also said that nursing homes that give workers consistent schedules that allow them to work with the same patients have also been successful.

“That helps reduce difficult behaviors with patients with dementia because staff knows the patients so well, they pick up on early signs of trouble and prevent a catastrophic event, so they can intervene early,’’ she said. Consistent schedules have the side benefit of helping nursing homes retain their workers longer, Bonner said. “Once this is in place, it turns out it is less expensive because staff turnover is expensive,’’ she said.

The education campaign will draw on the work of Dr. Susan Wehry, a geriatric psychiatrist and associate professor of psychiatry at the University of Vermont College of Medicine. Wehry recently concluded an intensive, nine-month pilot project in four Vermont nursing homes that taught all staffers, from housekeepers to medical directors, alternative approaches, such as using music and massage, to manage difficult patient behaviors.

The program, she said, helped identify which alternatives work, which don’t, and how challenging the mission can be.

Wehry is still analyzing the results but said preliminary findings showed that in one of the homes where the administrator made all of the training sessions mandatory for staff, antipsychotic use was dramatically reduced. A third of the patients with dementia had been prescribed antipsychotics before the program, and not one was on them by the end, she said.

“They were much improved in terms of staff-resident interactions and level of alertness,’’ Wehry said. “And they looked happier.’’

Data from another home that did not make all of the training mandatory showed no change in the number of dementia patients given the medications. Wehry said a more troubling trend also emerged there — one of the physicians switched from giving antipsychotics to prescribing antianxiety medications.

“If all we do is shift the burden, then all we have done is create a different set of problems,’’ Wehry said. “Our goal is not to just reduce our reliance on antipsychotics, but to change [patient] behaviors.’’

Kay Lazar can be reached at klazar@globe.com

via boston.com

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