Wall Street Journal Examines Debate Over Use Of Antipsychotics To Calm Symptoms Of Dementia Patients

Main Category: Alzheimer's / Dementia
Also Included In: Psychology / Psychiatry
Article Date: 21 Dec 2007 - 6:00 PDT

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The Wall Street Journal on Thursday examined how the "challenge of caring for rising numbers of seniors who suffer from dementia and the behavior problems that can stem from it has provoked a wrenching debate" over the use of atypical antipsychotics to calm symptoms in such patients.

Federal law discourages the use of physical restraints on dementia patients, but federal programs such as Medicaid cover the cost of medications used to calm symptoms in such patients. In 2005, Medicaid spent $5.4 billion on atypical antipsychotics, more than any other class of medications. Labels for atypical antipsychotics include a "black box" warning about increased risk for death among elderly dementia patients.

Last year, CMS implemented new rules to limit the use of antipsychotics, but currently "it's still easier for nursing homes to get reimbursed for giving patients extra pills than it is for hiring more staff" to care for dementia patients.

Cynthia Rudder of the Long-Term Care Community Coalition said that nursing home employees "are basically quieting" dementia patients "against their will," adding that "it is absolutely horrendous." Larry Minnix, president of the American Association of Homes and Services for the Aging, said, "We cannot treat people by simply throwing antipsychotic drugs at them for our convenience."

Senate Finance Committee ranking member Chuck Grassley (R-Iowa) earlier this month asked several pharmaceutical companies to provide documents about efforts to market the medications directly or indirectly for use in nursing home patients.

According to Dennis Smith, director of the Center for Medicaid and State Operations at CMS, nursing homes should seek a "different model" of care to ensure that "unlocking the drug cabinet" is not their only response to the symptoms of dementia patients. CMS also seeks to offer nursing homes alternatives and inform them that they "will be open to scrutiny," Smith said (Lagnado, Wall Street Journal, 12/10).

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