GAO: Antipsychotic overuse “widespread” for dementia

There is widespread overuse of psychiatric drugs by older Americans with Alzheimer’s disease or dementia who live at home or in assisted living facilities, according to a new General Accountability Office (GAO) report.

While the Obama administration has already been working with nursing homes to reduce the inappropriate use of antipsychotic medications, the government’s efforts need to expand to people with dementia who live at home or in assisted living facilities. Medicare officials should take immediate action to reduce unnecessary prescriptions, according to a The New York Times article on the report.

The Department of Health and Human Services “has taken little action” to reduce the use of antipsychotic drugs by older adults living outside nursing homes, the report said.

The GAO’s analysis found that about one-third of older adults with dementia who spent more than 100 days in a nursing home in 2012 were prescribed an antipsychotic, according to data from Medicare Part D. Among Medicare Part D enrollees with dementia living outside of a nursing home that same year, about 14 percent were prescribed an antipsychotic.

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Experts GAO spoke with noted that antipsychotic drugs are often initiated in hospital settings and carried over when older adults are admitted to a nursing home. ”In addition, experts and research have reported that nursing home staff levels, particularly low staff levels, lead to higher antipsychotic drug use,” the report stated.

While the National Alzheimer's Plan has a goal to improve dementia care for all individuals regardless of residence, HHS officials said that efforts to reduce antipsychotic use have not focused on care settings outside nursing homes.

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Stakeholders GAO spoke to indicated that educational efforts similar to those provided for nursing homes should be extended to other settings. “Extending educational efforts to caregivers and providers outside of the nursing home could help lower the use of antipsychotics among older adults with dementia living both inside and outside of nursing homes,” the report stated.

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