A GAO report released this week has found nationwide overuse of antipsychotic drugs for people with dementia. The focus of the report was explicitly outside of nursing homes. While 1 in 3 nursing home residents with dementia are given typically unnecessary and dangerous antipsychotics as chemical restraints, the GAO found that 1 in 7 Medicare beneficiaries with dementia (about 170,000 people overall) outside of a nursing home are given antipsychotics.
The report is helpful in identifying the level of antipsychotic use outside of nursing homes and analyzing how much of the use is unnecessary and harmful but the real value is in the call to action it extends to the federal government. Antipsychotic misuse in nursing homes has been the subject of a great deal of attention from the federal government and we have begun to see improvements in limiting antipsychotic use and better dementia care overall. But virtually no attention has been paid to antipsychotics in assisted living facilities or other home settings and now we know there are about 170,000 reasons why we should. Or perhaps there are 363 million reasons – the amount of dollars spent by Medicare Part D in 2012 for antipsychotic drugs for beneficiaries 66 years and older with dementia.
The report does not provide much in terms of recommendations for action other than to say the government ought to extend educational and outreach efforts to non-nursing home settings. That sounds nice but it’s a pretty flabby approach to such a serious problem. We would like to see greater efforts to limit Medicare Part D’s profligate approval of antipsychotic prescriptions and to improve informed consent processes in non-nursing home settings. We need real policy efforts to actively discourage and curb antipsychotic use.
It’s great the GAO has exposed the overuse of antipsychotics for people with dementia who don’t live in nursing homes. That exposure is long overdue. But ultimately, other federal agencies are going to have to answer the call and take some action.