Alice Bonner, one of the architects of CMS’s national initiative to reduce antipsychotic use in nursing homes, has co-authored a study investigating why antipsychotics are so often used on nursing home residents with dementia. The study, published in the Feb. 2015 Journal of the American Geriatrics Society, concluded that rationales for antipsychotic use in nursing homes vary widely but many of the indications for use are not FDA-approved and have little evidence of efficacy.
The study reinforces what advocates and others have known for a long time: the primary reason for giving antipsychotics to nursing home residents is to restrain them. The sedating effects of antipsychotics, which contribute substantially to their dangers, are what nursing home staff members are after. Stopping aggression was a common rationale as was addressing “behaviors.” A significant number of interviewees cited “movement” as a rationale for antipsychotic use. Could there be a more blatant description of raw chemical restraint use?
One interesting disparity in the reporting was that non-prescribing interviewees cited psychosis or other psychiatric diagnosis as a justification far more frequently than prescribers did. That may be because prescribers have much less incentive than nursing home workers to conceal chemical restraint use. Associating antipsychotic use with an FDA-approved indication like psychosis may be a way for non-prescribers (i.e. nursing home nurses) to better “justify” the drugging.
The study found that much work remains to be done to educate nursing home care providers about treatment approaches for people with dementia. Until some of the poor performers have more incentive to obtain that education, however, the chemical restraint beat will certainly go on.