News and Resources

   
6/4/2016 A New Approach to Dementia Care
Boston Globe
5/16/2016 Nursing Homes Urged to Rethink Drugging People with Dementia
Toronto Star
10/1/2015 Can Nursing Homes Get 300,000 Dementia Patients off Deadly Antipsychotics?
Al Jazeera, “America Tonight”
8/8/2015 Antipsychotics, Elderly Can Be a Toxic Mix
Utica Observer-Dispatch
7/20/2015 25% of Texas Nursing Home Residents Getting Dangerous Antipsychotic Drugs
CBS Channel 19 KYTX
6/10/2015 One Nation, Under Sedation: Medicare Paid for Nearly 40 Million Tranquilizer Prescriptions in 2013
ProPublica
5/20/2015 Calming Dementia Patients Without Powerful Drugs
KQED News
4/30/2015 The Elderly Are Taking Too Many Pills
Huffington Post
4/26/2015 The Right to Be Free of Chemical Restraints
The Fort Morgan Times
3/19/2015 Nurse Leaders Improve Dementia Care
Long Term Living
3/18/2015 Risks Run High When Antipsychotics Are Prescribed for Dementia
NPR
3/18/2015 Antipsychotics, Depakote, and Antidepressants: Deadlier than Thought for Dementia Patients
WebMD
3/15/2015 Empathy: The Future of Dementia Care
California Health Report
3/11/2015 Drugging Dementia: Are Antipsychotics Killing Nursing Home Patients?
Al Jazeera, “America Tonight”
3/2/2015 GAO Report Urges Fewer Antipsychotic Drugs For Dementia Patients
NPR
3/1/2015 Psychiatric Drug Overuse is Cited by Federal Study
The New York Times
1/26/2015 Dementia On the Rise: It’s Time to Deal with It
WNPR
1/16/2015 Tennessee Nursing Home Named in Wrongful Death Suit
Greenville Sun
12/9/2014 Old and Overmedicated: The Real Drug Problem in Nursing Homes
NPR
12/9/2014 Nursing Homes Rarely Penalized for Oversedating Patients
NPR
12/9/2014 This Nursing Home Calms Troubling Behavior Without Risky Drugs
NPR
10/23/2014 Groups Agree Overuse of Antipsychotic Drugs an Issue in Kansas Nursing Homes
Kansas Health Institute
10/21/2014 Care Home Faces Class Action Suit
Ventura County Star
10/1/2014 Blumenthal Hosts Discussion on Use of Antipsychotic Drugs
New Haven Register
9/23/2014 CMS’ Plan to Cut Antipsychotic Use in Nursing Homes Falls Short, Critics Say
Modern Healthcare
9/10/2014 Reducing Certain Medications Makes ‘Huge Difference’ for Some Dementia Patients
Global News
9/5/2014 Feds Hope Hitting Nursing Homes in the Wallet Will Cut Overmedication
NPR
9/5/2014 Families Sue Newbury Park Nursing Home Over Drug-Consent Issue
Ventura County Star
8/22/2014 Strong Drug Case Settled
Ventura County Star
7/18/2014 “Alive Inside” Shows How Music Can Break Through the Fog of Dementia
Scientific American
3/7/2014 Behavioral Therapies Better Than Antipsychotics for Dementia Patients, Nurses Say
The Washington Post
2/4/2014 Nursing Home Settlement Alters How Drugs Are Administered
Ventura County Star
11/20/2013 Dementia Patients Still Getting Dangerous Antipsychotic Drugs in Nursing Homes
Forbes
11/4/2013 J&J to Pay $2.2 Billion in Risperdal Settlement
New York Times
9/23/2013 Doctors: Anti-psychotic meds overused for dementia, kids
USA Today
9/12/2013 NC Leads Nation in Lowering Antipsychotic Drug Use in Nursing Homes
Newsobserver.com
8/26/2013 Nursing Homes’ Drug Use Falls
The Wall Street Journal
8/12/2013 Long-Term Care Advocate Wins Award
Ventura County Star
7/17/2013 Anti-psychotic Drugs to Nursing Home Patients Protested
Enterprisenews.com
7/14/2013 Nursing Homes Temper Their Reliance on Drugs
NewJersey.com
7/12/2013 Sedative Use Drops at Nursing Homes
Boston Globe
6/18/2013 Overuse of Antipsychotic Meds Risks Lives of the Elderly
Orange County Register
5/20/2013 The Sense of an Ending
The New Yorker
4/3/2013 Most Dementia Patients Can Safely Stop Antipsychotics
Medscape
3/7/2013 Local Nursing Homes Leading Movement to Reduce Chemical Restraints
Ventura County Star
3/1/2013 Weaning Nursing Homes From Their Dependence On Antipsychotics
Gotham Gazette
2/25/2013 Investigation: How NYC Nursing Homes Drug Seniors Into Submission
Gotham Gazette
2/4/2013 The Battle Against Chemical Restraints Inside Nursing Homes
New Hampshire Public Radio
1/31/2013 High Use of Antipsychotics in Connecticut Nursing Homes Stirs Concerns, Reforms
New Haven Register
1/9/2013 Former Nursing Director Sentenced to 3 Years for Inappropriately Medicating Patients
Bakersfield Californian
1/9/2013 Attorney General Kamala D. Harris Announces Nurse Sentenced to 3 Years in Prison for ‘Convenience Drugging’ Elder Patients
Press Release, California Department of Justice
1/8/2013 Medical Board Allows Over-Drugging of Elderly Patients
Mercury News Op-Ed, Anthony Chicotel
12/23/2012 Mass. Fails to Rein in Sedating of Seniors
Boston Globe
10/19/2012 Shocking Rise in Dementia Patients on ‘Zombie Drugs’
Daily Express UK
10/11/2012 Last Defendant in Elder Abuse Case Takes Plea Deal
Bakersfield News
10/2/2012 Blumenthal & Advocates for Elderly Target ‘Chemical Restraint’ Abuse at Care Facilities
The Connecticut Mirror
9/21/2012 Senators Blumenthal, Kohl, Grassley Seek to Protect the Elderly and Taxpayers from Abusive Overprescribing of Antipsychotics
Press Release
8/30/2012 J&J Will Pay $181 Million to Settle Risperdal Ad Claims
Bloomberg.com
8/29/2012 Former Nursing Home Administrator Sentenced
KGET.com
8/17/2012 Minister Alarmed by Dementia Treatment
The Australian
8/13/2012 The False Promise of Dementia Drugs
The Baltimore Sun
7/17/2012 Big Drop in Antipsychotic Drug Use for Dementia Patients
Community Care – Britain
7/13/2012 Stop Misusing Antipsychotics for Seniors
Newsday
7/13/2012 Southwestern PA Antipsychotic Drug Use Raises Concern
Pittsburgh Business Times
6/11/2012 Government Plans to Reduce Antipsychotic Use by 15 Percent by End of Year
Channel 10 – San Diego News
5/7/2012 Abbott Settles Marketing Lawsuit
The New York Times
5/7/2012 Abbott Labs to Pay $1.5 Billion to Resolve Criminal & Civil Investigations of Off-label Promotion of Depakote
U.S. Department of Justice
5/7/2012 Attorney General Kamala D. Harris Announces National Settlements with Abbott Laboratories
State of California, Department of Justice
5/1/2012 AARP Joins Antipsychotic-Drug Lawsuit Against Ventura Nursing Home
Ventura County Star
4/30/2012 Finding Alternatives to Potent Sedatives
The Boston Globe
4/29/2012 A Rampant Prescription, A Hidden Peril
The Boston Globe
4/26/2012 Drugs, Dementia and Nursing Homes
Forbes
4/19/2012 Feds Urge Cuts in Use of AntiPsychotic Drugs for Seniors
HealthLeaders Media
4/11/2012 J.&J. Fined $1.2 Billion in Drug Case
The New York Times
4/03/2012 Nursing Homes Won’t Have to Hire Independent Pharmacists
Bloomberg
3/21/2012 Hidden data show that antipsychotic drugs are less effective than advertised
The Washington Post
3/12/2012 Antipsychotic drugs grow more popular for patients without mental illness
The Washington Post
3/05/2012 Abuse of Mind-Altering Drugs Rises in Eldercare Facilities
Redwood Age.com New America Media
3/05/2012 Drugmakers have paid $8 billion in fraud fines
USA Today
2/23/2012 Drugs Raise Death Risk in Dementia Patients
ABC News
2/23/2012 FTC Drops Challenge of Omnicare Bid for PharMerica
bizjournals.com
2/22/2012 Specific Antipsychotic Drugs Increase Risk of Death in Elderly Dementia Patients
BMJ.com press release
1/27/2012 FTC Sues to Block Omnicare’s Bid to Buy Rival Pharmacy Provider PharMerica
Federal Trade Commission
1/27/2012 Nursing Home Investigation Finds Errors by Druggists
The New York Times, The Bay Citizen
1/24/2012 Senate Watchdog Targets High-Prescribing Medicaid Docs
ProPublica, Dollars for Doctors – How Industry Money Reaches Physicians
1/18/2012 Antidepressants Might Raise Fall Risk in Nursing Homes
Yahoo.com, HealthDay News
1/10/2012 Johnson & Johnson Said to Agree to Pay $1 Billion for Mis-marketing Risperdal
San Francisco Chronicle
12/21/2011 Gone Without a Case: Suspicious Elder Deaths Rarely Investigated
ProPublica & PBS Frontline
12/02/2011 Elderly Patients Over-Prescribed Antipsychotic Drugs, Concerns About Overuse on Nursing Home Patients
NY Daily News.com
11/03/2011 Glaxo to Pay $3 Billion to Settle U.S. Cases on Sales, Marketing, Avandia
Bloomberg
10/21/2011 Abbot Said to Agree to Pay $1.3 Billion for Depakote Suits
Business Week
09/20/2011 Doctors rarely pay penalties in kickback cases
Denver Post
09/15/2011 Antipsychotics: Nursing homes rethink use of drugs
San Francisco Chronicle
09/08/2011 What the doctor ordered: Patients should know if their doctors get paid by drug firms
LA Times
08/26/2011 Suit alleges abuse at Seal Beach nursing home: Former patient says she was forcibly medicated
Orange County Register
08/26/2011 ‘Awakenings’ changes the way meds are handled at nursing home
Detroit Lakes Tribune
08/11/2011 Let them eat chocolate, says advocate of change in senior care
Ventura County Star
07/07/2011 Painkillers ‘may ease agitation’ in dementia patients
BBC News
05/31/2011 Cause for Alarm: Antipsychotic drugs for nursing home patients
CNN
05/26/2011 Drugging the Vulnerable: Atypical Antipsychotics in Children and the Elderly
Time
05/16/2011 Top brain specialist calls for ban on antipsychotics in elders
The Boston Globe
05/11/2011 Audit: Common psychiatric meds can be deadly for elderly
California Watch
05/10/2011 Grassley says report on use of anti-psychotic drugs is an outrage
Radio Iowa
05/09/2011 Antipsychotic Drugs Called Hazardous for the Elderly
New York Times
05/09/2011 Government finds nursing homes misuse antipsychotics
CBS Evening News
05/09/2011 Nursing Home Residents Receive Powerful Antipsychotic Drugs for Off-label Uses, Inspector General Report Shows
Press Release by Senators Grassley and Kohl
05/09/2011 Overmedication of Nursing Home Patients Troubling
Daniel R. Levinson, Inspector General, DHHS
05/01/2011 The Ethics of Antipsychotics in Alzheimer’s
Caring for the Ages, Jonathan Evans, MD, MPH, CMD
04/23/2011 Taylor-Stein: Make ‘least drugging’ a nursing home norm
Ventura County Star
03/24/2011 Use of chemical restraints in nursing homes called an epidemic
Ventura County Star
03/21/2011 Reducing Antipsychotic Drug Use in Nursing Homes: Save Residents’ Lives, Save Medicare Billions of Dollars
Center for Medicare Advocacy
03/19/2011 California lawsuit accuses Bristol-Myers Squibb of fraud, kickbacks
LA Times
03/10/2011 Attorney General Kamala D. Harris and 37 Other Attorneys General Announce $68.5 million Settlement Over Deceptive Marketing of Antipsychotic Drug Seroquel
California Office of the Attorney General
03/02/2011 Johnson & Johnson appeal denied, kickback case moves on in federal court
McKnight’s Long Term Care News
03/02/2011 Questions Raised Over Antipsychotic Usage On Elderly: Groups Trying to Prevent Misuse of Psychoactive Drugs on Elderly Patients
10News.com San Diego
02/15/2011 Clearing the Fog in Nursing Homes
New York Times
12/31/2010 Giving Alzheimer’s Patients Their Way, Even Chocolate
New York Times
12/04/2010 Nursing homes are seeking to end the stupor
Minneapolis Star Tribune
11/18/2010 Mass. aims to cut drug overuse for dementia
The Boston Globe
10/02/2010 Side Effects May Include Lawsuits
New York Times
07/23/2010 I-Team Investigates Chemical Restraint Of Elderly
10 News – San Diego
04/26/2010 For $520 Million, AstraZeneca Will Settle Case Over Marketing of a Drug
New York Times
04/2010 10 Things Nursing Homes Won’t Tell You
SmartMoney Magazine
03/10/2010 Risperdal Pushed for Elderly After U.S. Warning, Files Show
Bloomberg
03/08/2010 Nursing home drug use puts many at risk
Boston Globe
01/15/2010 US Attorney says: J&J Paid Kickbacks to Boost Sales
Associated Press
01/15/2010 United States Files Suit Against Drug Manufacturer Johnson & Johnson For Paying Kickbacks To Nation’s Largest Nursing Home Pharmacy
US Dept. of Justice – Press Release
01/11/2010 Overmedication in the Nursing Home
New York Times
01/11/2010 Antipsychotics Still Widely Used in U.S. Nursing Homes
Off-label use to control behavior seems to be part of the ‘culture’ at some centers, one study finds

Business Week
01/05/2010 3 Nursing Home Patients Killed by ‘Chemical Restraints’
California Attorney General Says Nursing Director Drugged Patients to Control Them

ABC News
11/12/2009 Chemical restraints killing dementia patients
Guardian UK Guardian
11/03/2009 Nation’s Largest Nursing Home Pharmacy and Drug Manufacturer to Pay $112 Million to Settle False Claims Act Cases
U.S. Department of Justice
10/28/2009 Compromised Care: Nursing home doctors untouched even as facilities are cited –
Part 2

Chicago Tribune
10/27/2009 Compromised Care: Psychotropic drugs given to nursing home patients without cause -Part 1
Chicago Tribune
10/27/2009 Sedated hours after moving in, newcomer fell and later died
Chicago Tribune
10/27/2009 5 things to know about psychotropics
Chicago Tribune
09/08/2009 Administrator charged in nursing home druggings
Bakersfield Now
09/03/2009 ANTI-PSYCHOTIC DRUG BILL BECOMES NATIONAL ISSUE AS TWO MULTI-BILLION COURT CASES ARE SETTLED
Press Release by California Senator Elaine Alquist
09/02/2009 Justice Department Announces Largest Health Care Fraud Settlement in Its History
U.S. Department of Justice
05/14/2009 Nursing home used outdated consent forms in Risperdal case
The Lakeland Times
03/19/2009 When it comes to dementia, forget the drugs
Los Angeles Times
02/23/2009 Families wonder if their loved ones were overdrugged
The Bakersfield Californian
02/20/2009 3 arrested in nursing home deaths in Lake Isabella
Los Angeles Times
02/20/2009 Nursing facility trio pleads not guilty to charges of overmedicating patients
The Bakersfield Californian
02/20/2009 Drugs used at Kern nursing home can be deadly for elderly
The Bakersfield Californian
02/19/2009 How did accused nurse keep getting hired?
The Bakersfield Californian
02/19/2009 Reports detail fatal druggings at nursing facility
The Bakersfield Californian
01/16/2009 Lilly settles Zyprexa suit for $1.42 billion
Los Angeles Times
01/15/2009 Heart risk cited in newer antipsychotic drugs
Los Angeles Times
01/14/2009 Lilly Said to Be Near $1.4 Billion U.S. Settlement
New York Times
01/08/2009 Alzheimer’s drugs double death risk in elderly
Chico Enterprise Record
06/24/2008 Doctors Say Medication Is Overused in Dementia
The New York Times
06/17/2008 FDA Orders Warning Label on Older Antipsychotics
The Washington Post
06/10/2008 State investigating Kern Valley nursing home again
The Bakersfield Californian
03/27/2008 Study: California Nursing Homes Use Restraints Most Frequently
California Healthline
03/09/2008 People with dementia getting drugged rather than helped
Minneapolis Star Tribune
01/04/2008 Drugs Offer No Benefit in Curbing Aggression, Study Finds
The New York Times
12/04/2007 Prescription Abuse Seen In U.S. Nursing Homes
Powerful Antipsychotics Used to Subdue Elderly; Huge Medicaid Expense

The Wall Street Journal
12/20/2007 Nursing homes struggle to kick drug habit
The Wall Street Journal
11/18/2007 Dementia relief, with a huge side effect:
The off-label use of some drugs is helping elderly patients,
but may be killing thousands

St. Petersburg Times

Help drugging victims by taking action against responsible parties!

One of the best ways to help stop the drugging of nursing home residents is to hold nursing homes and doctors accountable when they engage in this practice. If you, a family member, or friend has been harmed by misuse of antipsychotic drugs or other types of psychoactive drugs, here are actions you can take to fight the drugging and to seek justice.

Take legal action: Drugging of nursing home residents is not only dangerous, it is against the law. You can go to court to enforce the law and, if someone has been harmed, to seek compensation from those who are responsible. CANHR’s Lawyer Referral Service can refer you to a qualified elder abuse attorney. Call us at 1-800-474-1116 to discuss your case.

File a complaint against the nursing home: California nursing homes are licensed and inspected by the California Department of Public Health (CDPH). Although CDPH is a big part of the problem – it rarely takes strong action against nursing homes that misuse antipsychotic drugs and has fought legislative reforms – it is a good idea to file a complaint with it. The more complaints on drugging that are filed with CDPH, the more pressure it will face to take action. It must begin investigating your complaint within 10 working days, or within 24 hours if it involves imminent danger to a resident. Read CANHR’s fact sheet, How to File a Nursing Home Complaint, for instructions. Call CANHR if you have questions or if CDPH is not responding properly.

File a complaint with the Bureau of Medi-Cal Fraud & Elder Abuse (BMFEA): The BMFEA is a division of the California Attorney General’s office that investigates and prosecutes crimes against nursing home residents. Misusing antipsychotic drugs to chemically restrain nursing home residents can be a very serious crime, as evidenced by the BMFEA’s charge that the practice amounted to “assault with a deadly weapon” in a pending criminal case against a Kern County nursing home administrator, director of nursing, pharmacist and doctor. There are three ways to file your complaint: (1) Call the BMFEA at 800-722-0432; (2) File your complaint on-line at http://www.ag.ca.gov/bmfea; or (3) Mail a copy of your complaint to the California Department of Justice, Bureau of Medi-Cal Fraud & Elder Abuse, P.O. Box 944255, Sacramento, CA 94244-2550.

File a complaint against the doctor: When doctors order psychoactive medications (including antipsychotic drugs) without obtaining informed consent, they are violating the law. File a complaint against the doctor through the Medical Board of California.

Contact the media: Nothing gets a nursing home’s attention faster than the local media. Consider asking the media to help expose dangerous drugging practices.

Alert state legislators: CANHR is working to strengthen California laws against the drugging of nursing home residents. You can help by informing your state senator and assembly member about the inappropriate use of psychoactive drugs. Find your legislators at: http://www.leginfo.ca.gov/yourleg.html

Click here to sign our petition and join our campaign.

Please send CANHR copies of complaint letters and other correspondence at: CANHR, 650 Harrison Street, 2nd Floor, San Francisco, CA 94107-1311

Drugs should always be the last resort for treating behavioral symptoms of dementia, not the first option.

Nursing homes and doctors often excuse their use of antipsychotic drugs on their residents with dementia by claiming they “had no choice.” There is rarely any truth to this excuse, since there are better options for treating the symptoms of dementia.

For more information on helpful alternatives to the use of antipsychotic drugging, check CANHR’s guide — Toxic Medicine: What You Should Know to Fight the Misuse of Psychoactive Drugs in Nursing Homes.

Literature

Alzheimer’s Association ADvancing Care(TM), is a series of informative newsletters from the Alzheimer’s Association’s New York City chapter to guide family, friends, and caregivers in maximizing the quality of life of people with dementia. Topics include interpreting resistance to care, addressing sundowning, and enhancing mealtimes.

Encouraging Comfort Care: A Guide for Families of people with Dementia Living in Care Facilities, is a free online booklet published by the Greater Illinois Chapter of Alzheimer’s Association. The 21-page booklet provides helpful information to families and long-term care facilities personnel about care issues related to the late and final stages of dementia. Its focus is on keeping elders with dementia comfortable, and off unnecessary psychoactive drugs, by individualizing their care and anticipating their needs.

Dementia Beyond Drugs: Changing the Culture of Care, by Dr. Allen Power, is an excellent book aimed at caregivers and administrators in nursing homes and other residential facilities. First published in 2010, the book is available from Amazon.com and other web sources. For more information on Dr. Power, visit his website at: http://www.alpower.net/Pages/edenpublications.htm

Connecting the Dots, by Dr. Judith London, teaches several practical, nonpharmacologic techniques to maintain strong relationships and meaningful connections with people with dementia.

Nonpharmacologic Management of Behavioral Symptoms in Dementia, by Laura N. Gitlin, Helen C. Kales, and Constantine G. Lyketsos, Care of the Aging Parent: From Evidence to Action, November 21, 2012.

Bathing Without a Battle is an acclaimed book that focuses on one of the most common reasons nursing homes give for drugging residents: resistance to nursing home-style bathing. It describes thoughtful and humane approaches to bathing and was updated in 2008 to address other issues, including pain, skin care, transfers, the environment and determining the appropriate level of assistance. Its lessons about individualized care can easily be applied to other aspects of care. It is available from Amazon.com and other web sources.

Dementia Care: The Quality Chasm, by the Dementia Initiative, is a white paper examining dementia care in the U.S. The authors are critical of the current disease-centered/pharmacologic approach to treatment and instead tout person-centered care as the “gold standard.” The paper discusses the operational practices of person-centered care focused on meaningful lives for people with dementia and caregiver commitment to holistic approaches.

Model Programs and Facilities

The Dementia Action Alliance: This British coalition of government, advocacy, human service, academic and provider organizations is seeking to transform the quality of life of people living with dementia in the UK. In June 2011, it issued a strong call to action urging that all persons with dementia who are receiving antipsychotic drugs be examined to determine if the drugs are really needed and to ensure that alternatives to drugs have been considered. In support of its call to action, the Dementia Action Alliance has produced a best practice guide on optimizing care for behavioral symptoms of dementia. Additionally, the British Alzheimer’s Society has dedicated a section of its website to misuse of antipsychotics.

Beatitudes Campus, Phoenix Arizona: Beatitudes is a non-profit, church affiliated retirement community that features a dementia unit, Vermillion Cliffs, which is receiving national attention for its successful caregiving practices for persons with advanced dementia. The dementia training staff at Beatitudes is active in Arizona and national educational efforts to teach and promote humane care methods. Vermillion Cliffs was the focus of a prominent New York Times article on December 31, 2010: Giving Alzheimer’s Patients Their Way, Even Chocolate. Information on the Beatitudes Dementia Training Program is available at: http://www.beatitudescampus.org/aging-research-and-training/palliative-care-for-advanced-dementia-program/

Ecumen, Minnesota: Ecumen is a non-profit, church affiliated organization that offers facility and community-based long term care in Minnesota. Its Awakenings project is an initiative to reduce the use of antipsychotic drugs among nursing home residents who have dementia. It grew out of a pilot program in which Ecumen worked with physicians, employees, residents and their family members over the course of six months to eliminate the use of antipsychotic drugs, while substantially improving residents’ life quality. Awakenings is the subject of a December 4, 2010 Minneapolis Star Tribune article: Nursing Homes Are Seeking to End the Stupor. Information on the Awakenings project is available at: http://www.changingagingblog.org/posts/view/1343-reducing-antipsychotic-medications-in-nursing-homes-ecumen-awakenings-initiative/

St. Leonard Franciscan Living Community, Dayton, Ohio: St. Leonard reports cutting use of anti-anxiety drugs by 70% in less than a year using comforting and stimulating interventions that its founders call Behavior-Based Ergonomics Therapy (BBET). The facility reports that residents who suffer from dementia are safer and more satisfied, its staff is pleased, and the program is cost-effective. It was featured in March 2011 edition of Long-Term Living at: http://www.ltlmagazine.com/article/engaged-and-transformed

Vermont Gold Star Nursing Home Project: This project is training nursing home staff members to shift their focus from intervention to prevention by teaching them how to determine what distressed persons with dementia are communicating. Information is available at: http://susanwehrymd.com/About/goldstar/goldstar.html

Programs and Legal Actions

Training Programs

Antipsychotic Medication Use in Nursing Homes offers training geared to federal and state nursing home surveyors on dementia care and the misuse of antipsychotic medications but also has a great deal of information that would be helpful to anyone who cares for someone with dementia.

Dining with Friends is a 20-minute training video on a model dining program presented by the Alzheimer’s Resource Center of Connecticut. It gives thoughtful recommendations on how to make the dining experience in long term care facilities dignified, friendly, appetizing and nutritious for people with advanced dementia.

PEARL Specialized Dementia Care is a British caregiver training program focused on increasing patient well-being and reducing antipsychotic medication. The caregivers’ training includes a simulation to give them the experience of what it feels like to have dementia. The program has had excellent results.

Snoezelen Rooms are therapy rooms where patients can receive visual, tactile, and other sensory stimulation using lights, images, and objects to touch.

State Actions

Massachusetts Department of Public Health: The State of Massachusetts launched a campaign in November 2010 to reduce the inappropriate use of antipsychotic medications for residents with dementia. A team of specialists are identifying nursing homes with successful methods for avoiding unnecessary use of antipsychotics and are planning trainings for nursing home staff on non-pharmacologic interventions. A November 18, 2010 story in the Boston Globe describes the campaign at: http://www.boston.com/news/health/articles/2010/11/18/ mass_aims_to_cut_drug_overuse_for_dementia/

Congressional Hearings

U.S. Senate Special Committee on Aging: On November 30, 2011, the Aging Committee held a hearing titled: Overprescribed: The Human and Taxpayers’ Costs of Antipsychotics in Nursing Homes. Experts testified that antipsychotics are dangerous and expensive for “treating” dementia and are typically surpassed by simple nonpharmacologic options. Statements from presenters are posted on the Committee’s website at: http://aging.senate.gov/hearing_detail.cfm?id=335005

Antipsychotics Harm and Kill Elderly People with Dementia:

Title: The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial

First Listed Author: Ballard

Year: 2009

Message: Increased risk of death for elderly people with dementia on antipsychotics continues over long-term. At three years, about one-third of patients on antipsychotics are alive while about two-thirds of those on a placebo are alive.


Title: Psychotropic Drug Prescription and the Risk of Falls in Nursing Home Residents

First Listed Author: Cox, Claudia A.

Year: 2016

Message: Psychotropic drugs are associated with a nearly 3-fold increase in falls for nursing home residents.


Title: Use of Antipsychotics and Risk of Myocardial Infarction

First Listed Author: Zheng-he Yu

Year: 2016

Message: Antipsychotic use is significantly associated with heart attack risk.


Title: Antipsychotics, Other Psychotropics, and the Risk of Death in Patients with Dementia

First Listed Author: Maust

Year: 2015

Message: Antipsychotics, Valproic Acid (Depakote), and Anti-Depressants are associated with increased risk of death in people with dementia. The absolute mortality risk of antipsychotics may be higher than previously reported and increases with dose.


Title: Antipsychotic Use in Parkinson’s Disease is Associated with Increased Mortality

First Listed Author: Weintraub

Year: 2015

Message: Antipsychotics increase the risk of death by 2.35 times over an 180-day period for people with Parkinson’s Disease.


Title: Falls and Fractures with Atypical Antipsychotic Medication Use

First Listed Author: Fraser

Year: 2015

Message: Antipsychotics given to elderly people increase risk of falls and falls with fractures by 50% within 90 days of administration.


Title: Number Needed to Harm: Antipsychotics and the Risk of Death in Patients with Dementia

First Listed Author: Maust

Year: 2014

Message: Mortality risks with antipsychotics are higher (at least double) than previously reported, particularly when patients are observed over longer periods of time. “The balance of benefit to risk of antipsychotic treatment in dementia continues to shift.”


Title: Psychotropic Medications, Including Short Acting Benzodiazepenes, Strongly Increase the Frequency of Falls in the Elderly

First Listed Author: van Strien

Year: 2013

Message: Elderly people taking a psychotropic drug (antipsychotic, anti-anxiety, anti-depressant) were twice as likely to report having fallen three or more times in the past year.


Title: Atypical Antipsychotic Drugs and the Risk for Acute Kidney Injury and Other Adverse Outcomes in Older Adults

First Listed Author: Hwang

Year: 2014

Message: Atypical antipsychotics significantly raise risk of acute kidney injury, hypotension, acute urinary retention, and neuroleptic malignant syndrome for older adults.


Title: Antipsychotic Therapy and Short-term Serious Events in Older Adults with Dementia

First Listed Author: Rochon

Year: 2008

Message: Older adults prescribed atypicals are 3.2 times more likely to suffer adverse events (i.e. hospitalization, fall, fracture, stroke, heart attack, death). Those prescribed conventional antipsychotics were 3.8 times more likely.


Title: Antipsychotic Agents and Sudden Cardiac Death – How Should We Manage the Risk?

First Listed Author: Schneeweis

Year: 2009

Message: Antipsychotics have no measured benefit on treating elderly people with dementia but enhance risk of death. Use should be reduced sharply.


Title: Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death

First Listed Author: Ray

Year: 2009

Message: Current use of atypicals and conventional antipsychotics double the risk of sudden cardiac death.


Title: Risk of death associated with the use of Conventional versus Atypical Antipsychotic Drugs among Elderly Patients

First Listed Author: Schneeweis

Year: 2007

Message: All antipsychotics raise the risk of death for elderly with dementia but conventionals are worse than atypicals.


Title: Risk of death in elderly users of conventional vs. atypical antipsychotic medications

First Listed Author: Wang

Year: 2005

Message: All antipsychotics raise the risk of death for elderly with dementia but conventionals are worse than atypicals. Atypicals: nearly double risk of death (60-70% higher), Conventionals’ risk of death is 37% higher than atypicals’


Title: Antipsychotic Drugs and the Acute Respiratory Distress Syndrome

First Listed Author: Wilson

Year: 2005

Message: Antipsychotics can cause neuroleptic malignant syndrome which may be associated with acute respiratory distress

Forget Dementia, Antipsychotics are Dangerous to Anyone Over 40

Title: Comparison of Longer-Term Safety and Effectiveness of 4 Atypical Antipsychotics in Patients Over Age 40: A Trial Using Equipoise-Stratified Randomization

First Listed Author: Jin

Year: 2012

Message: Antipsychotics caused high incidence of metabolic syndrome and serious adverse and nonadverse events. Antipsychotics are dangerous and not a favorable treatment, irrespective of diagnosis or drug.

Antipsychotics Don’t Do Much Good and Less Intrusive Measures Are Better:

Title: Effect of Intravenous Haloperidol on the Duration of Delirium and Coma in Critically Ill Patients (Hope-ICU)

First Listed Author: Page

Year: 2013

Message: Haldol proved no better than a placebo in managing delirium in an adult intensive care unit.


Title: Nonpharmacologic Management of Behavioral Symptoms in Dementia

First Listed Author: Gitlin

Year: 2012

Message: There is strong evidence for using nonpharmacologic treatment to yield high levels of patient and caregiver satisfaction and quality of life.


Title: Withdrawal Versus Continuation of Chronic Antipsychotic Drugs for Behavioural and Psychological Symptoms in Older People with Dementia

First Listed Author: Declercq

Year: 2012

Message: There is very little difference in “behavioral deterioration” for patients with dementia who are withdrawn from antipsychotic drugs versus those who are not. People with dementia can be withdrawn from antipsychotics without detrimental effects on their behavior. Care providers should incorporate plans to discontinue antipsychotic drugs into routine clinical care.


Title: Efficacy of Treating Pain to Reduce Behavioural Disturbances in Residents of Nursing Homes with Dementia

First Listed Author: Husebo

Year: 2011

Message: Agitation was significantly reduced for dementia patients who were administered regular acetaminophen.  Results compared well to best currently available drug therapy.  Pain management could reduce need for psychotropic drugs for treating dementia.


Title: A Randomised, Blinded, Placebo-Controlled Trial in Dementia Patients Continuing or Stopping Neuroleptics (The DART-AD Trial)

First Listed Author: Ballard

Year: 2008

Message: Patients with Alzheimer’s Disease who were withdrawn from antipsychotics had no detrimental effect to their functional or cognitive status.


Title: Cost-benefit Analysis of Second-Generation Antipsychotics and Placebo in a Randomized Trial of the Treatment of Psychosis and Aggression in Alzheimer Disease

First Listed Author: Rosenheck

Year: 2007

Message: Placebo led to cheaper total health costs and no noticeable difference in quality of life or measures of function than when antipsychotics were used.


Title: Effectiveness of Nonpharmacological Interventions for the Management of Neuropsychiatric Symptoms in Patients with Dementia

First Listed Author: Ayalon

Year: 2006

Message: Non-drug interventions can be more effective than drugs and should be used first. Pain, fatigue, and other issues may be the cause of behavioral problems.


Title: CATIE-AD Trial – Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer’s Disease

First Listed Author: Schneider

Year: 2006

Message: Any benefits of atypicals for treating psychosis, aggression, or agitation in patients with Alzheimer’s are offset by adverse effects. Patients treated with drugs had more parkinsonism, sedation, confusion, and cognitive disturbances.


Title: Cognitive Effects  of Atypical Antipsychotic Medications in Patients with Alzheimer’s Disease: Outcomes from CATIE-AD

First Listed Author: Vigen

Year: 2011

Message: People with dementia who are given antipsychotics show significantly greater rates of decline in cognitive function than those who received a placebo.


Title: Effect of Enhanced Psychosocial Care on Antipsychotic Use in Nursing Home Residents with Severe Dementia

First Listed Author: Fossey

Year: 2006

Message: Facilities that dedicated themselves to non-medication alternatives reduced their drug usage by half with no significant differences in the levels of agitation or disruptive behavior in the residents.


Title: Pharmacological Treatment of Neuropsychiatric Symptoms of Dementia

First Listed Author: Sink

Year: 2005

Message: Psychiatric drugs are not particularly effective for the management of neuropsychiatric symptoms of dementia. The drugs should be used only as a last resort if at all and only after environmental causes of symptoms have been first ruled out.

Other Classes of Psychotropic Drugs Are Deadly for Elderly People in Nursing Homes; In Fact, More Deadly than Atypical Antipsychotics:

Title: Risk of Death and Hospital Admission for Major Medical Events after Initiation of Psychotropic Medications in Older Adults Admitted to Nursing Homes

First Listed Author: Huybrechts

Year: 2011

Message: After looking at 10,900 nursing home residents over a 10 year period, conventional antipsychotics, antidepressants, and anti-anxiety drugs were associated with greater risk of death than even atypical antipsychotics.


Title: Effect of Anxiolytic and Hypnotic Drug Prescriptions on Mortality Hazards: Retrospective Cohort Study

First Listed Author: Weich

Year: 2014

Message: People taking anti-anxiety or sleeping drugs in the first year died at a rate more than three times greater than those who didn’t. Over 7.6 years, the death rate of those taking the drugs was twice as high of those who didn’t. The death rate of the studied people taking the drugs was 26.46 out of 100.  For those who didn’t take the drugs, the death rate was 16.82 out of 100.

Anti-Anxiety Drugs Associated with Increased Risk of Dementia:

Title: Benzodiazepines and Risk of Alzheimer’s Disease

First Listed Author: Yaffe

Year: 2014

Message: Use of anti-anxiety drugs such as Xanax, Ativan, Klonoppin, and Valium are associated with significantly increased risk of Alzheimer’s Disease.


Title: Benzodiazapene Use and Risk of Alzheimer’s Disease: Case-Control Study

First Listed Author: Billioti de Gage

Message: Long-term use (over 90 doses – even if spread out over years) of benzodiazapenes correlated with much higher incidence of Alzheimer’s Disease. 180-plus doses nearly doubles the risk of Alzheimer’s.

Anti-Depressants Are Ineffective and Dangerous for Treating Depression in Dementia:

Title: Fall and Fracture Risk in Nursing Home Residents with Moderate-to-Severe Behavioral Symptoms of Alzheimer’s Disease and Related Dementias Initiating Antidepressants or Antipsychotics

First Listed Author: Yu-Jung Wei

Year: 2016

Message: Antidepressant users with dementia who live in nursing homes experienced significantly higher risk for falls and fractures than even antipsychotic users.


Title: Dose-response relationship between Selective Serotonin Reuptake Inhibitors and Injurious Falls: A Study in Nursing Home Residents with Dementia

First Listed Author: Sterke

Year: 2012

Message: Use of SSRI anti-depressants are associated with significant increases in fall risks for nursing home residents with dementia. The higher the dose, the greater the risk.


Title: Sertraline [Zoloft] or Mirtazapine [Remeron] for Depression in Dementia (HTA-SADD): a Randomised, Multicentre, Double-blind Placebo-controlled Trial

First Listed Author: Banerjee

Date: 2011

Message: Anti-depressants are no better than a placebo than treating depression in people with dementia. Due to the increased risk of adverse events associated with the use of anti-depressants, they should not be used as a first-line of treatment of depression in dementia.

Depression is Significantly Over-Diagnosed:

Title: Clinician-Identified Depression in Community Settings: Concordance with Structured-Interview Diagnoses

First Listed Author: Mojtabai

Year: 2013

Message: More than 60% of people diagnoses with depression do not meet the clinical criteria for depression. Depression is overtreated (with antipdepressants).

Facilities Drug Use Rates are Driven by Staff Convenience and Facility Culture, Not Residents’ Needs:

Title: Variation in Nursing Home Antipsychotic Prescribing Rates

First Listed Author: Rochon

Year: 2007

Message: Large variation in rate of drugging in nursing homes cannot be explained by variation in residents. Some nursing homes must be better than others.


Title: Exploring the Link Between Organizational Climate and the Use of Psychotropic Medicines in Nursing Homes: A Qualitative Study

First Listed Author: Sawan

Year: 2017

Message: A facility’s organizational climate heavily influences its psychotropic drug usage, with staffing levels and training, managerial expectations, and teamwork the three most influential dimensions.


Title: Unexplained Variation Across US Nursing Homes in Antipsychotic Prescribing Rates

First Listed Author: Chen

Year: 2010

Message: Facility level prescribing rates depend on the facility, not the resident. Facility preferences determine its drugging rate. 16.4% of residents with no clinical indication for antipsychotics nonetheless received them.

Drugs Are Often Given Without Clinical Indications:

Title: Increasing Off-label Use of Antipsychotic Medications in the United States, 1995-2008

First Listed Author: Alexander

Year: 2011

Message: Use of antipsychotic drugs has risen dramatically from 6.2 million “treatment visits” in 1995 to 14.3 million in 2008. Use among the elderly increased 23% during that time. Off-label use more than doubled from 4.4 million treatment visits to 9.0 million and the costs of off-label drugs increased 7.5-fold from $0.8 billion to $6.0 billion.


Title: The Quality of Antipsychotic Drug Prescribing in Nursing Homes

First Listed Author: Briesacher

Year: 2005

Message: Use of antipsychotics has risen. Most atypicals prescribed outside of prescribing guidelines for doses and indications. Only 41.8% has appropriate dosage and indications for use. 23.4% no indications for use, 17.2% too high doses, 17.6% had both problems. Those on antipsychotics had no appreciable difference in quality of life.


Title: Provision of Psychopharmacological Services in Nursing Homes

First Listed Author: Molinari

Year: 2009

Message: 70% of all Medicaid residents receive a psychoactive within three months of admission even though most have no psychiatric diagnosis nor any prior use.


Title: Use of Antipsychotics among Nonagenarian Residents in Long-term Institutional Care in Finland

First Listed Author: Alanen

Year: 2006

Message: Residents with socially disruptive behaviors are mush more likely to receive an antipsychotic than those with good social skills


Title: Broadened Use of Atypical Antipsychotics: Safety, Effectiveness, and Policy Challenges

First Listed Author: Crystal

Year: 2009

Message: Most use for residents is without an FDA diagnosis. 22.6% of residents with dementia but no psychosis and no behavioral symptoms receive an antipsychotic. Physicians responding to pressure that “something needs to be done.”


Title: Off-Label Use of Second-Generation Antipsychotic Agents Among Elderly Nursing Home Residents

First Listed Author: Kamble

Year: 2010

Message: 23.5% of the country’s nursing home residents in 2004 received at least one prescription for a second-generation antipsychotic drug and that 86.3% of the use was off-label. Only 56.9% of the off-label use was evidence-based; 43% of off-label use “was without strong scientific support, suggesting a less than optimal quality of care in nursing homes.” The off-label use could be due in part to pharmaceutical promotion, growing scientific support, and prescribers’ training and personal experience.” Residents with a diagnosis of dementia were 3.2 times more likely to receive off-label drugs; 71% of residents taking off-label drugs had a diagnosis of dementia.

Informing Patients of Drug Risks Leads to Decreased Use:

Title: Trends in Antipsychotic Use in Dementia 1999-2007

First Listed Author: Kales

Date: 2011

Message: Use of atypical antipsychotic for outpatient treatment of dementia began to decline in 2003 when FDA Black Box warnings were required. Nursing home patients were not part of the study.


Title: Impact of FDA Black Box Advisory on Antipsychotic Medication Use

First Listed Author: Dorsey

Year: 2010

Message: FDA Black Box warning label on atypical antipsychotics was associated with decreased use, especially among elderly patients. Informing patients of drug risks could reduce misuse of antipsychotic drugs.

Some nursing homes must be better than others.


Title: The Impact of OBRA-87 on Psychotropic Drug Prescribing in Skilled Nursing Facilities

First Listed Author: Borson

Year: 1997

Message: New federal laws targeting nursing home quality of care, including psychotropic drug use, decreased use of antipsychotic drug use by almost 35% from 1989-1992.  Focused reform efforts can reduce use.

Education Programs Will Reduce Psychotropic Drug Rates:

Title: A Randomized Trial of a Program to Reduce the Use of Psychoactive Drugs in Nursing Homes

First Listed Author: Avorn

Date: 1992

Message: Educational outreach program to nursing homes designed to increase the selectivity of psychoactive drug use was associated with significant reduction of use. Resident cognition also improved in the educated nursing homes.


Title: Reducing Antipsychotic Drug Prescribing for Nursing Home Patients: A Controlled Trial of the Effect of an Educational Visit

First Listed Author: Ray

Year: 1987

Message: One-time personal visits by trained physician counselors to doctors who were frequent prescribers of antipsychotic drugs in nursing homes did not reduce antipsychotic drug prescriptions. The authors concluded that nursing staff (not physicians) may be key to therapeutic decisions and that more intensive interventions than a single educational visit is needed to change prescribing habits.

Increased Regulatory Scrutiny Lowers Antipsychotic Use:

Title: Response to Regulatory Stringency: The Case of Antipsychotic Medication Use in Nursing Homes

First Listed Author: Bowblis

Year 2011

Message: A ten-percentage point increase in the proportion of facilities that receive a deficiency for unnecessary drug use decreases the proportion of residents who receive an antipsychotic by 0.45 percent.

 

 

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