Nov. 18, 2022 – An attempt by the federal government to stop a practice known as “chemical restraint” at nursing homes may have resulted in many residents being given different medications to achieve the same results.

The new federal report is a follow-up to concerns raised in 2011 that psychiatric medications known as antipsychotics were being given to dementia patients to subdue them so they were easier to care for safely by nursing home staff. 

In 2011, the U.S. Department of Health and Human Service’s investigation found that 80% of Medicare nursing home residents were being prescribed psychotropic medications. This classification includes antipsychotic medicines, as well as other similar types of drugs that affect thoughts and behaviors. Since then, the department has sought to reduce the use of antipsychotics. 

But the latest follow-up study shows that 80% of Medicare nursing home residents continue to be prescribed psychotropic drugs, just a different kind: anticonvulsants.

“While [the Centers for Medicare & Medicaid Services] focused its efforts to reduce the use of one category of psychotropic drug – antipsychotics – the use of another category of psychotropic drug – anticonvulsants – increased,” the report authors summarized. “This increased use of anticonvulsants contributed to the overall use of psychotropics remaining constant.”

Anticonvulsants are drugs mostly known for treating epilepsy, which is a seizure disorder. These medicines are also widely used in psychiatry, including for treating schizophrenia. The new study showed a dramatic increase in schizophrenia being reported by nursing home staff.

“The inappropriate use of dangerous and powerful medications hasn’t really changed, and that is really disturbing,” Richard Mollot, executive director of the Long Term Care Community Coalition, a nursing home watchdog group, told The Washington Post.

The findings came from reviewing data from 2011 to 2019 for nursing home residents. The data was matched to their Medicare Part D prescription drug claims information, allowing researchers to identify residents receiving psychotropic drugs. The researchers said they “did not assess the administration of or medical necessity of psychotropic drugs for nursing home residents.”

Researchers had three suggestions:

  • Review the need for the psychotropic prescriptions
  • Have more oversight on nursing homes with unusually high rates of residents taking those medications
  • Add more required reporting so medications can be matched to the intended diagnoses.

Show Sources

U.S. Department of Health and Human Services, Office of Inspector General: “Long-Term Trends of Psychotropic Drug Use in Nursing Homes.”

The Washington Post: “Epilepsy drugs as ‘chemical restraint’ on rise in nursing homes.”

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