According to a recent report by the International Psychogeriatrics Association, one in five older adults living in Europe with a functional impairment receives long-term care in a long-term care facility. Over 50% of these older adults suffer with dementia and often are challenged by some kind of neuropsychiatric symptoms throughout the progression of the disease. These patients commonly express challenging behaviors that include verbal and physical aggression, depression, agitation, wandering, sleep disturbances, oppositional behaviors, and psychotic symptoms. Presently, not many pharmacologic options exist for the treatment of neuropsychiatric symptoms. However, elderly residents with dementia are frequently prescribed psychotropic medications.
The number of prescriptions given to these vulnerable patients is appalling, considering that these drugs have a limited effect in treating neuropsychiatric symptoms and the serious side effects that this patient population suffer from. Sedation, impaired motor function, increased rate of cognitive decline, and risk of falls are some of these negative side effects. The issue with the most controversy in regards to the treatment of neuropsychiatric symptoms is the use of antipsychotics. These drugs are related to an exacerbated risk of extrapyramidal effects, pneumonia, stroke, and death. Various other psychotropic medications that include antidepressants, anti-dementia drugs, anxiolytics, and hypnotics also result in side effects and are thus an inappropriate alternative. Nursing home residents are often prescribed psychotropic drugs even though the US Food and Drug Administration (FDA) established warnings and mandated changes to the prescribing information for a psychotropic drug previously in 2003. Other warnings have come from the European Medicines Agency (EMA)—in 2004, the EMA issued a public announcement that olanzapine increases the risk of cerebrovascular negative outcomes and mortality in older adult patients with dementia. The EMA’s warnings continued in subsequent years. Moreover, national drug agencies in France, Italy, Spain, the United Kingdom (UK), and other countries publicly warned about the higher risk of mortality related to antipsychotics back in 2004 and 2005. Some countries have also published drug safety warnings.
Although many warnings of European and national drug agencies, as well as clinical guidelines, have existed since the year 2004, prescription of psychotropic medications still occurs far too often for patients with dementia. recent study aimed to examine the prescription rates of psychotropic medication use in elderly patients residing in nursing homes between various Western European countries since the warnings were first published through a systematic review.
A literature review was conducted and the variety of psychotropic medication prescription rates in nursing homes throughout Western Europe were investigated. The rates that antipsychotics and antidepressants were prescribed were pooled for each country.
The study found that the use of antipsychotic drugs in nursing homes ranged from 12% to 59% and antidepressant use from 19% to 68%. The highest rates of antipsychotic medication prescription were identified in Ireland, Austria, and Belgium, while the highest rates for antidepressant use was found in Sweden, Belgium, and France.
The study concluded that despite the numerous warnings regarding the negative side effects and recommendations to use non-pharmacological interventions, nursing homes still frequently rely on antipsychotics and antidepressants on their patients. This common practice is found in nursing homes throughout the United States, as well. It is not only inappropriate to prescribe these kinds of medications when non-pharmaceutical approaches could be used instead, it can be extremely dangerous and harmful to an older adult’s wellbeing and quality of life. If you or a loved one has been abused or neglected in a nursing home or assisted living facility, such as one in Glendora or Hawaiian Gardens, California, please contact the Law Offices of Ben Yeroushalmi today.