Assisted living residents with dementia receiving too many antipsychotics, GAO says

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Government investigators are calling for greater scrutiny of antipsychotics' use among residents with dementia in settings beyond nursing homes.

Nearly a third of elderly dementia residents spending more than three months in nursing homes wind up taking the powerful drugs, Government Accountability Office investigators found after combing through databases of the Medicare Part D prescription drug program. A smaller yet no less disturbing number (14%) of individuals with dementia also are being prescribed antipsychotics in home settings and assisted living communities, prompting the GAO this week to advise the Department of Health and Human Services to initiate greater oversight and educational outreach.

In a report issued publicly on Monday, the GAO observed that although the drugs may be prescribed appropriately to address issues in residents expressing agitation or delusions, they have been shown by the FDA to pose an increased risk of death in people who have dementia and psychosis simultaneously.

Sen. Thomas Carper (D-DE) told the New York Times the report shows that “many seniors with dementia are receiving risky mind-altering medications.” The GAO report notes that “antipsychotic drugs are often initiated in hospital settings and carried over when older adults are admitted to a nursing home,” where conditions like inadequate staffing could lead to their over-use.

The GAO report acknowledges that HHS agencies already are addressing antipsychotic drug use by older adults in nursing homes under the auspices of the National Alzheimer's Plan, but none of those efforts have been focused in settings like assisted living facilities.

Recent evidence has shown a dramatic decline of antipsychotics use in nursing homes. In a statement, the American Health Care Association / National Center for Assisted Living noted the GAO recognizing the progress of the industry. Although there is more to be done, "we have the knowledge and the desire to achieve these goals on behalf of the thousands we serve," said spokesman Greg Crist.

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