Context is everything with antipsychotics and the elderly
James M. Berklan
It seems if you want to stir up a sizable dustball of commotion these days, all it takes is a sprinkle of the word “antipsychotics” here and there. Trust us, we know.
It was just last week that we dared relay that a known consumer advocacy group was gasping about approximately 1 in 5 nursing home residents taking antipsychotics. Perhaps it was the clever way that “about 20%” was translated. I don't know.
But enough non-mathematician civilians (journalists included) have problems any time a number rises above their age, so horror on both sides of the issue ensued. The rub is that long-term care providers have openly acknowledged that their collective usage levels are, in fact, “around” 20% — actually lower with each passing measurement. So maybe a little closer to 1 in 6 than 1 in 5 in some instances.
The bigger issue is that so-called consumer groups seem intent on whipping up a frenzy. The last time I was at a long-term care trade show, I was struck by how many lunch partners casually brought up the fact that antipsychotics are, in fact, needed and necessary for many in their care. Unrelated groups brought up the same topic time and again.
The providers talked about having their hands tied behind their back by the antipsychotics uproar and backlash. They were truly down about the pressure to restrict meds so much, even when these drugs would be the most appropriate thing for the job at hand.
(Another sign that people might be taking their eye off the ball is that despite the heavy focus on skilled nursing practices, off-label use of antipsychotics has creeped up well into double digits in assisted living and other community settings, as one of our recent guest bloggers so eloquently noted.)
I suppose it's no surprise then, that such roadblocks have caused detours into other, perhaps sketchier neighborhoods.
At least one study has shown that to compensate for this pressure, providers might be shifting more toward mood stabilizers, whose use rose 2.5% recently. This real kick here is that mood stabilizers are in a class of drug that the MDS does not measure. Who, in the know, didn't see that coming?
Whether it's a case of “watch the right hand so you don't notice what the left hand is doing,” is unclear at this point.
But it's important to highlight that antipsychotics often are the right option for some individuals. Honing in on antipsychotics and their use without considering the rest of the landscape is too often coming up with an answer in search of a problem.
Follow Editor James M. Berklan @JimBerklan.