Antipsychotic drug use decrease higher than expected

Use of antipsychotic medications in long-stay nursing home residents has experienced a greater-than-expected decrease, according to new data reported at a recent meeting of the National Partnership to Improve Dementia Care in Nursing Homes, a public/private collaboration directed by the Centers for Medicare & Medicaid Services (CMS).

According to CMS quality data, 19.2 percent of long-stay nursing home residents were receiving an antipsychotic medication in the third quarter of 2014 compared with 23.9 percent in the fourth quarter of 2011, a decrease of 19.4 percent.

Mark Parkinson, president and CEO of the American Health Care Association (AHCA), says that his organization’s quality initiative, begun three years ago, has played a role in the drop. One of the four goals of the AHCA initiative, launched in February 2012, is a 15 percent reduction in the off-label use of antipsychotic medications. That goal mirrored one set by the CMS partnership, which AHCA also joined in 2012.

“Now that we have exceeded our initial objective, we have set even more ambitious goals to further decrease the use of antipsychotics in skilled nursing centers an additional 10 percent nationwide by the end of 2015 and another 5 percent by the end of 2016,” Parkinson said in a statement.

Sept. 19, the National Partnership to Improve Dementia Care in Nursing Homes announced new goals of reducing the use of the drugs in skilled nursing facility residents by 25 percent by the end of 2015 and by 30 percent by the end of 2016; both percentages are in relation to a baseline rate from the fourth quarter of 2011. Those goals build on an initial reduction of 15.1 percent (with total use decreasing nationwide from 23.8 percent to 20.2 percent), which occurred over time from 2011 to 2013.

“The use of antipsychotic medication as an attempt to modify behaviors associated with dementia is not supported by the research studies,” said David Gifford, MD, MPH, AHCA’s senior vice president of quality and regulatory affairs and a board-certified geriatrician. “These medications may be appropriate for individuals suffering from schizophrenia or bipolar disorder, but in the elderly living with dementia, they can increase the risk of complications, resulting in poor health outcomes and higher costs.”

LeadingAge and AMDA‒The Society for Post-Acute and Long-Term Care Medicine also have been active in the partnership and are among the organizations expressing support for the reduction in use of antipsychotic medications in long-stay nursing home residents.

Data exclude residents with diagnoses of schizophrenia, Huntington’s disease or Tourette’s syndrome. Source: National Partnership to Improve Dementia Care in Nursing Homes, Jan. 23.

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