The Silent Epidemic: Overmedication in America's Nursing Homes

A recent study by NPR of government data found that despite a federal campaign for nursing homes to reduce use of antipsychotic drugs, penalties were rarely assigned to facilities who failed to comply with government guidelines. While dementia is a major cause of disability among older adults and increases with diseases such as Alzheimer's or strokes, too often, those who suffer from syndromes such as loss of memory, aggression, and other physical difficulties are prescribed medications that, at best, are simply ineffective, and in the worst case scenarios, may lead to toxic drug interactions that can be fatal.

Study by American Geriatrics Society Confirms Harm of Over-Medicating Seniors

In 2012, the American Geriatrics Society released a study that found significant medication-related problems in older adults, many of which were preventable. Specifically, the study concluded that 27 percent of adverse drug events (ADEs) in primary care and 42 percent of ADEs in long-term care were preventable, with most problems occurring at the ordering and monitoring stages of care.

Within the long-term care community, the prevalence of "potentially inappropriate medications" (PIMs) has long been known. In fact, since the early 1990s, PIM usage has been the subject of more than 500 studies. Yet, despite the consensus in the health community of the harms of over-medicating patients, the trend of prescribing or adding drugs to older adults' regimens continues in both doctors' offices and long-term care facilities.

Additionally, the interdisciplinary panel also updated the "Beers Criteria," which are guidelines used to minimize harmful drug-related accidents among the elderly. In particular, the panel highlighted 53 potentially inappropriate medications and placed them in one of three categories: drugs to avoid in general in the elderly, drugs to avoid in the elderly with certain diseases and syndromes, and drugs to use with caution for the elderly only if there are no viable alternatives.

Despite the study's findings, NPR own investigation found that two years later, many states are still playing catch-up to comply with federal guidelines to prevent overmedicating nursing home residents. Texas in particular has low rates of compliance and many nursing homes within the state has reported simply losing the training course DVDs sent by the Centers for Medicare and Medicaid Services (CMS). Moreover, there is no evidence that CMS has taken actions against either the long term care facilities or individual state in an effort to enforce patients' rights to be free from "chemical restraints" such as antipsychotic medications.

Important Questions To Ask Before Admitting a Loved One

With CMS unable or unwilling to hold long-term care facilities accountable, it is up to family members to ensure that a loved one will be appropriately cared for upon admission. Because placing a parent or grandparent in a nursing home can be a difficult time, families should prepare a checklist of questions to ask the facility's staff during the admissions process. These may include:

  • How many staff are there for each resident and shift and what are their responsibilities?
  • Is there special training for staff about dementia and Alzheimer's disease? What protocols are in place to deal with symptoms such as aggression?
  • What types of emergencies are staff expected to handle and how are they trained?
  • Does the facility prepare a written plan describing medication regimens?

If you are concerned about a loved one's treatment at a long term care facility, contact The Pittman Firm today to speak with one of our experienced elder care attorneys.

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