MARY LOUISE KELLY, HOST:
Tens of thousands of people in nursing homes are being given antipsychotic drugs even though they don't have schizophrenia or other serious mental illnesses. What they do have in most cases is Alzheimer's disease or another form of dementia. A new study from Human Rights Watch says these drugs are used to sedate residents to make them more manageable even though the FDA says the drugs are dangerous. NPR's Ina Jaffe covers aging and has our report.
INA JAFFE, BYLINE: Antipsychotic drugs come with what are called black box warnings from the FDA. The warnings say elderly patients with dementia-related psychosis are at an increased risk of death if given these drugs. Hannah Flamm, the author of the Human Rights Watch study, says that government agencies have been warning about the dangers of these drugs in older patients since the 1970s.
HANNAH FLAMM: And more than 40 years later, the problem persists.
JAFFE: Flamm found that 179,000 nursing home residents are receiving antipsychotic medication even though a federal law says that they have the right to be free of, quote, "chemical restraints." Those are drugs that are administered for the sole purpose of making residents docile. Flamm found that the government doesn't enforce that law.
FLAMM: Our quantitative analysis found that between 2014 and 2017, 97 percent of citations for inappropriate use of antipsychotic drugs, there was no mandatory financial penalty that attached.
JAFFE: This closely matches an NPR analysis of government enforcement data from a couple of years earlier, which found that only 2 percent of the citations issued for unnecessary use of antipsychotics were rated severe enough to trigger a fine. Advocates for nursing home residents have long attributed the overuse of antipsychotic drugs to inadequate staffing. Toby Edelman, a senior policy attorney with the Center for Medicare Advocacy, says many nursing homes don't hire enough workers to handle the residents without using drugs.
TOBY EDELMAN: So until we have more professional nurses and more nurse aides, we're not really going to be able to deal with this problem.
JAFFE: But there have been improvements. In 2012, the government began a program in partnership with the nursing home industry to help facilities deal with the challenging symptoms of dementia without using powerful drugs. Since then the use of antipsychotics has dropped by about a third.
DAVID GIFFORD: And that is a dramatic change.
JAFFE: Says Dr. David Gifford, a senior vice president at the American Health Care Association, which represents most nursing homes. He says his industry should get credit, not just criticism.
GIFFORD: But I believe that there is clear room for further improvement.
JAFFE: Some nursing homes still use antipsychotics too often, says Gifford. On the other hand, if a patient is hallucinating, antipsychotics could be helpful.
GIFFORD: To not use the medications and to try to get people off of them would be terribly inappropriate and harmful to residents.
JAFFE: But Hannah Flamm says that 179,000 nursing home residents are not hallucinating on a regular basis. So giving them antipsychotics...
FLAMM: May rise to the level of forced medication and cruel, inhuman and degrading treatment under international human rights standards.
JAFFE: The government tracks the rate of antipsychotic use at each individual nursing home. That information is available to the public on the website NursingHomeCompare. Ina Jaffe, NPR News.
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