Today, Senator Richard Blumenthal (D-Conn.) proposed action to stop "chemical restraint" of dementia patients -- the overprescribing of antipsychotic drugs to treat dementia patients who may be agitated or confused. Misuse of antipsychotic drugs is prevalent despite a Federal Drug Administration box warning concerning the increased risk of mortality and other harmful side effects.
Blumenthal was joined by Nancy Shaffer, Connecticut Long-Term Care Ombudsman, Eleonora Tornatore-Mikesh, the Executive Director of the Alzheimer's Association -- Connecticut Chapter, Ann Spenard, the Vice President of Program Operations at Qualidigm, and Michelle Page, the Director of Clinical Service and Consulting at CAP Pharmacy.
Blumenthal said, "Excessive prescription of antipsychotic drugs in nursing homes is elder abuse -- plain and simple. It is chemical restraint, as pernicious and predatory as unnecessary physical restraint. While these drugs have warnings against using them off-label to treat elderly or frail patients, an alarming majority of Medicare claims are still for victims of dementia. We must to do more to encourage responsible and judicious use of antipsychotic drugs, including requirements for informed consent. Abuse of these drugs is dangerous to patients -- and taxpayers -- wasting hundreds of millions in Medicare funds."
Shaffer said, "Senator Blumenthal's legislative proposal addresses a critical Connecticut problem by providing a strong basis for patient safety by requiring informed consent before an anti-psychotic drug is administered. The legislation will also build on the work of the Partnership to Improve Dementia Care in nursing homes which has been a wonderful opportunity for stakeholders to collaborate and create better strategies for caring for residents with dementia. We know that off-label antipsychotic prescriptions for elders is not the answer to managing the unique behaviors associated with dementia. Together, I hope we can better educate the leadership in the long-term care setting and provide direct caregivers with training and supervision so that residents are able to maintain the high quality of life they so very much deserve."
Tornatore-Mikesh said, "It is an exciting day, as the Alzheimer's Association -Connecticut Chapter has been a part of the interdisciplinary team, and we recognize the importance that training and an environmental assessment has on an individual with Alzheimer's or other dementia disorders."
Spenard said, "As the Quality Improvement Organization for Connecticut, Qualidigm is leading a state coalition with various industry stakeholders including the Department of Public Health, Department of Social Services and the Long-Term Care Ombudsman. This coalition is supporting nursing homes in reducing the use of off-label antipsychotics by 15 percent by the end of the year, as identified in the Partnership to Improve Dementia Care initiative. The coalition fully supports Senator Blumenthal's legislation, "Improving Dementia Care Treatment in Older Adults Act" S.3604.
Last month, Blumenthal joined Senators Herb Kohl (D-Wis.) and Chuck Grassley (R-Iowa) to introduce the Improving Dementia Care Treatment in Older Adults Act (S. 3604), legislation that would require the Secretary of Health and Human Services to develop a standardized protocol for obtaining informed consent prior to administering antipsychotics. The legislation would also create prescriber education programs that promote evidence-based treatments using objective informational materials. In addition, the legislation would use the drug regimen review process already in place at nursing homes to produce a monthly aggregate report of antipsychotic utilization for each facility.
Despite warnings from the Food and Drug Administration and the medical research community, antipsychotic prescription rates in nursing homes and long-term care facilities for patients with dementia and no diagnosis of psychosis remain high. An Inspector General report issued in 2011 found that 305,000 -- or 14 percent -- of the nation's 2.1 million elderly nursing home residents had at least one claim for these drugs. The report also found that 83 percent of Medicare claims for antipsychotic drugs for elderly nursing home residents were associated with off-label conditions and that 88 percent were associated with the condition specified in a warning issued by the Food and Drug Administration. Although the Food and Drug Administration has approved antipsychotic drugs to treat numerous psychiatric conditions, studies conducted during the last decade have concluded that these medications can be harmful when used on patients with dementia who do not have a diagnosis of psychosis.