Nursing homes may be over-medicating dementia patients with antipsychotic drugs despite mounting evidence of early death and minimal efficacy, according to a study published in JAMA Internal Medicine. Researchers at the University of Massachusetts Medical School found that off-label prescription of anti-psychotic drugs were a common practice in nearly 100 nursing homes in the state. However, undergoing the OASIS curriculum and training program helped reduce the number of off-label prescription, the research team said. The program provides nursing home professionals such as nurses and dietary staff with the knowledge, skills, and attitudes needed to care for dementia patients without resorting to medication.
As part of research, the experts pooled data from state-based nursing homes on OASIS intervention and found that off-label antipsychotic prescriptions showed a seven percent decline from 34 percent to 27 percent after nine months. In comparison, Massachusetts- and New York-based nursing homes that did not adapt the OASIS program only showed a four percent reduction from 23 percent to 19 percent.
“This is the largest study to show that it is possible to reduce antipsychotic use in the nursing home population. This intervention focused on treating the residents as human beings with needs, not as patients with problems. We don’t medicate babies when they cry or act out, because we assume that they have a need that we need to address. However, when people with dementia are unable to communicate, the current approach medicates them when they have undesirable behaviors,” said lead researcher Dr. Jennifer Tjia in an article in ScienceDaily.com.
The lead researcher also stressed that the staff in facilities using the OASIS intervention need to train periodically to maintain the reduced rates of off-label antipsychotic prescription.
Antipsychotics raise risk of premature death in patients
A vast number of studies have established a link between antipsychotic medications and their adverse side effects in dementia patients. A study published late last year revealed that antipsychotic drugs may elevate the risk of early death in older patients. As part of the study, researchers at University of Eastern Finland analyzed data from nearly 58,000 Alzheimer’s disease patients between 2005 and 2011. The research team found that patients taking antipsychotic drugs had a 60 percent increased odds of early death compared with nonusers. The study also revealed that the risk of early death was highest during the patients’ first intake. However, the risk persisted with long-term exposure to the medication. In addition, patients who took one or two antipsychotic drugs at the same time had a nearly twofold increased odds of dying early compared to those who didn’t. The results appeared in the Journal of Alzheimer’s Disease.
Another study found a link between antipsychotic drugs and premature death. To carry out the study, researchers at the University of Michigan Health System examined nearly 91,000 elderly American veterans and found that patients taking antipsychotic drugs were more likely to suffer premature death than nonusers. The research team also found a dose-dependent effect in patients taking newer, more commonly-used medications. Patients taking mood stabilizers also had increased odds of dying early, the study revealed. The study found that the odds of premature death were lower with antidepressant medications compared with antipsychotics and mood stabilizers. However, the overall risk of premature death was still higher in patients taking antidepressant than patients not taking any psychiatric drugs. The findings were published in JAMA Psychiatry.
A study published in the British Medical Journal found that certain antipsychotic drugs may raise the odds of death in dementia patients. Researchers at Harvard Medical School assessed 75,445 dementia patients and found that mortality risk was higher in patients taking haloperidol and quetiapine compared with those who were on risperidone treatment.