Sunday, June 03, 2012

Proper prescribing

Wrong use of strong drugs can be devastating

A prescription for the wrong medicine, or too much of the right one, can cause dullness, danger or even death for older people.

That’s the word from a growing group of family members, as well as medical, government and nonprofit groups working on medication issues involving older patients nationally.

Many people who have placed older relatives in long-term care tell the same story: a frail but communicative person goes into a facility and within a day or so their normal demeanor has changed so drastically as to be unrecognizable. Experts on aging, as well as government and business leaders, attribute such changes to widespread use of behavior-modifying medications, including strong antipsychotics such as Zypresa.

These prescriptions often are written “off-label,” or contrary to the use of the drug approved by the Food and Drug Administration, according to reports from the Centers for Medicare and Medicaid. A U.S. Inspector General’s report last year found that Medicare claims for improper use of antipsychotic drugs amounted to $116 million in six months.

Margaret Toman, of Garner, N.C., saw the effects herself when she placed her mother, in her 90s, in a nursing home.

“This person who has been resilient and cheerful all her life, was bawling and crying, asking me for help,” Toman said last week.

“They thought she was depressed. What they were giving her was supposed to be an anti-anxiety drug, but it didn’t work for her.”

Toman brought her mother home and saw her recover within two days, as the drug left her system.

Giving inappropriate drugs to control the behavior of older people may sound like a scenario out of a horror movie. For many of the antipsychotic drugs prescribed contrary to FDA labeling, a leading potential side effect is increased risk of death. But the syndrome is real, drawing the attention of regulators and advocates at all levels.

Last month, U.S. Sen. Chuck Grassley, R-Iowa, along with two Democratic senators, proposed an amendment on the topic to a massive FDA bill.

“This amendment responds to alarming reports about the use of antipsychotic drugs with nursing home residents,” Grassley said. “It’s intended to empower these residents and their loved ones in the decisions about the drugs prescribed for them.”

The amendment wasn’t part of the final bill, which still faces House consideration, but it shows a realization at the federal level that the problem isn’t going away. The nursing home industry faces a federal mandate to change practices, including a directive to reduce the use of antipsychotic drugs by 15 percent by the end of this calendar year.

Physicians contend that in some cases the powerful drugs are necessary, but they should be used only as a last alternative.

Along with physicians and advocates, federal regulators encourage those who look after older people to use methods other than drugs to accomplish their goals.

“Many of these individuals are scared, confused, frustrated and have difficulty communicating verbally, so they use behavior as their form of communication. As care providers, we need to listen,” said David Gifford, senior vice president for quality and regulatory affairs at the American Health Care Association, a nursing home group.

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