‘Phony’ Diagnoses Obscure Number of Nursing Home Residents Prescribed Antipsychotic Drugs

The New York Times Building, 620 Eighth Avenue, by Ajay Suresh. (This file is licensed under the Creative Commons Attribution 2.0 Generic license. The original file was resized and compressed.)

A front-page story appeared in last Sunday’s New York Times about the rampant prescribing of antipsychotic drugs and diagnosing of schizophrenia in nursing homes. A Times investigation found at least 21 percent of nursing home residents–about 225,000 people–are on antipsychotic drugs. Furthermore, one in nine residents have a diagnosis of schizophrenia. “In the general population, the disorder, which has strong genetic roots, afflicts roughly one in 150 people,” The Times adds.

The reason? Understaffed nursing homes would rather have agitated residents with dementia on antipsychotic drugs than hire more employees. These “chemical straitjackets,” as antipsychotic drugs have been called, “are dangerous for older people with dementia, nearly doubling their chance of death from heart problems, infections, falls and other ailments.”

According to The Times:

The risks to patients treated with antipsychotics are so high that nursing homes must report to the government how many of their residents are on these potent medications. But there is an important caveat: The government doesn’t publicly divulge the use of antipsychotics given to residents with schizophrenia or two other conditions.

That helps explain the “phony” diagnoses of schizophrenia in nursing homes, which rely on high star ratings for financial purposes. These star ratings from the government factor in antipsychotic drug use.

The Times also linked to a 2015 article in the peer-reviewed journal Neurology and Therapy that shows there’s an inverse relationship between a nursing home’s staffing situation and the prescription of antipsychotic drugs. In other words, the fewer the staff at a nursing home, the more that antipsychotic drugs are prescribed.

Adding fuel to the fire, the pandemic made matters worse. Nursing home staffing has decreased by more than 200,000 since early 2020 and is the lowest it’s been since 1994. With this decrease in staffing came an increase in antipsychotic drug use.

To circumvent federal regulators, nursing homes have turned to another medication, Depakote, a drug used to treat epilepsy and bipolar disorder. According to The Times: “The drug can make people drowsy and increases the risk of falls. Peer-reviewed studies have shown that it does not help with dementia, and the government has not approved it for that use.” Depakote even comes in a “sprinkle” form that can be added to food surreptitiously. Nursing homes are compelled to report to federal regulators how many of their patients take an assortment of psychotropic drugs, including antipsychotics, anti-anxiety medications, antidepressants, and sleeping pills. Yet they do not have to report Depakote or similar drugs to federal regulators.

If you can’t see the original New York Times article because it’s blocked by a paywall, you can read this article in Yahoo News that contains many of the main points.

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