Nursing homes pushed to reduce antipsychotic drug use by 15 percent this year

Federal regulators announced a multi-year initiative Wednesday to slash the inappropriate use of antipsychotic drugs in nursing home residents, saying that nearly 40 percent of residents with dementia were receiving the powerful sedatives though they didn’t have a condition that would warrant it.

The US Centers for Medicare & Medicaid Services said it was aiming to reduce the use of antipsychotic drugs in nursing home residents by 15 percent by the end of this year, through training of nursing home staff and state inspectors to use alternative methods instead of relying on antipsychotics to quell agressive and agitated behavior among people with dementia.

Alice Bonner, director of the agency’s nursing home division, said in an interview that the 15 percent reduction is just the first step.

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“In 2013 we will set another goal,” Bonner said. “At that point, we will be looking at even more significant reductions.”

Another agency official said during a conference call with reporters that between July and September of 2010, almost 40 percent of nursing home residents with signs of dementia were receiving antipsychotic drugs even though they had not been diagnosed with a psychosis.

The drugs have sometimes-lethal side effects, prompting the US Food and Drug Administration to issue two warnings since 2005 against using them in elderly patients with dementia.

Additional data from Bonner’s agency indicate that more than 17 percent of nursing home residents in 2010 were given daily doses of antipsychotics in excess of recommended levels.

“We believe these antipsychotics are over-prescribed,” said Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, a national trade association that has agreed to work with federal regulators to reduce use of the drugs.

“Many clinicians, physicians and family members believe these medications are useful and necessary, but data show otherwise,” Gifford said.

The Globe reported last month that in 21 percent of nursing homes nationwide in 2010, at least one-quarter of residents without illnesses for which antipsychotics are recommended received the medications. In Massachusetts, the proportion was 28 percent of homes.

Based on federal data, the newspaper estimated that about 185,000 nursing home residents nationwide received antipsychotics in 2010 contrary to nursing home regulators’ recommendations.

“Managing dementia without relying on medication can help improve the quality of life for these residents. The Partnership to Improve Dementia Care will equip residents, caregivers, and providers with the best tools to make the right decision,” said Dr. Patrick Conway, the agency’s chief medical officer and director of clinical standards and quality.

The agency said it will also post on its Nursing Home Compare website in July data on each nursing home’s use of antipsychotic drugs. The Globe posted data last month for each nursing home in the United States, obtained through a Freedom of Information Act request, showing the percentage of patients without a psychosis or related condition who nonetheless received antipsychotics.

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