Posted by Gary Ilminen, RN (209.83.13.56) on January 12, 2001 at 16:09:28:
Psychoactive Drug Use in Nursing Homes Soars
by Gary R. Ilminen, RN
Author of �Consumer Guide to Long-term Care� (University of Wisconsin
Press) for information, go to:
http://www.wisc.edu/wisconsinpress/books/3075.htm
(NOTE: Permission is granted by the author for non-commercial duplication,
use and distribution of this article by consumers, families, advocates,
professionals and anyone concerned about quality of care in nursing homes).
__________________________________________
According to data from the Health Care Financing Administration (HCFA), use
of psychoactive drugs among nursing home residents has continued to soar,
despite regulations intended to restrict their use. Psychoactive
medications are drugs that alter mood, behavior or mental processes. Drug
categories considered to be �psychoactive� or �psychotropic� include
antipsychotics, sedatives, hypnotics, anti-anxiety and antidepressant
drugs. Most of these drugs are known to cause numerous side effects,
particularly the antipsychotics, whose side effects can be permanent.
Since the passage of the Nursing Home Reform Act of 1987 (OBRA), federal
regulations have required that these drugs be used only when absolutely
necessary to treat an appropriate diagnosis or severe symptoms and only for
as long as necessary. Despite the regulations, use of psychoactive drugs
in the nation�s nursing homes has soared from 26.4 percent of all residents
in 1991 to 50.3 percent in 1999.
Part of the increase may be due to more frequent diagnosis and treatment of
major depression. However, according to HCFA data for the second quarter
of 2000, only 6.2 percent of nursing home residents were assessed as having
symptoms of major depression. The percentage of residents with other
psychiatric diagnoses has increased over the years, but they represented
only 13.8 percent of residents. That same data shows that 35.5 percent of
residents with �problem behaviors� were reported as receiving antipsychotic
medications in the absence of any psychotic or related conditions.
HCFA has recently touted the reduction in the use of physical restraints in
nursing homes, which has declined from 21.7 percent in 1991 to 10.9 percent
in 1999. However, the dramatic increase in psychoactive drug use suggests
physical restraints have simply been replaced by chemical restraints.
Consumers, families and advocates should question the use of all
medications, but particularly those given to �help with sleep,� �settle
him/her down,� �help with agitation or confusion,� or for �problem
behaviors.� Many of these problems have causes that can be addressed by
other means. Demand to know about side effects of the drug, whether
another drug is being given for the same reason, and when the drug will be
stopped. If the person receiving the drug becomes groggy, constantly
sleepy, unable to stand or walk, or declines in other ways, demand that the
need for the drug be reassessed.