Responding to the Overuse of Psychotropic Drugs for Seniors

Kathleen O'Connor Ives
Kathleen O’Connor Ives

By: State Senator Kathleen O’Connor Ives, September, 2013

In 2007 a federal audit found that about one in seven elderly residents were being given antipsychotic medication in nursing homes despite the fact that those drugs carry a “black box” warning from the Food and Drug Administration (FDA).

A “black box” warning is designed to call attention to serious or life-threatening risks. The audit also revealed that most of these antipsychotic medications were being used outside the FDA’s approved uses for treating schizophrenia and bipolar disorders.

Unfortunately, these psychotropic medications are being frequently prescribed to seniors residing in long-term care facilities to calm and sedate them, not because the medications are medically necessary on account of a condition. When patients are prescribed drugs in this way, perhaps they are easier to “handle,” but they are also being exposed to a much higher risk of death and complications in the process. Moreover, family and health care proxies deserve to know when patients are being given these medications so that they can be informed of the risks and advocate for the best interest of their loved ones. Very often, the patient/resident does not have the capacity to advocate for themselves.

In 2010, the Massachusetts Attorney General joined a federal lawsuit that contended that a pharmaceutical company was paid tens of millions of dollars in kickbacks to get its drugs, especially the powerful antipsychotic medication, Risperdal, prescribed in nursing homes. As of 2011, the Centers for Medicare and Medicaid Services (CMS) announced that “the national prevalence of antipsychotic use in nursing home residents has been reduced by 9.1 percent. Massachusetts introduced a pilot program to monitor eleven nursing homes in reducing the use of antipsychotic medications. In the first year, those eleven nursing homes were able to lower rates by 21 percent. Last year 104 other nursing homes were added to this program. Although this is an improvement, seniors are still being prescribed these medications without informed consent.

I have filed Senate Bill 303, “An Act Relative to Psychotropic Medications,” which would require nursing home, rest home, or other long term care facilities to first obtain informed, written consent from the competent patient, the resident’s health care proxy, or the court appointed Rogers guardian if psychotropic medications are to be administered. The facility must keep the written consent form on record and shall state the purpose, use and any potential side effects of the psychotropic medication.

This bill was first filed by my predecessor, Senator Steve Baddour on behalf of a constituent, Sharlene Hemp of North Andover. In 2001, Ms. Hemp’s father passed away from complications brought on by pneumonia. This was a result of side effects from anti-psychotic medication that were administered during his brief residency in a local nursing home. Although he had Alzheimer’s, he was otherwise healthy. The prescribing doctor was not found liable for his death but was found negligent for not informing the family of the medication that was being prescribed. In addition, the family was not informed of the potential for serious side effects from the medication.

This bill is currently in the Joint Committee on Elder Affairs and had a public hearing in June where I submitted testimony in support of the bill, as well as a request that the bill be released from Committee with a favorable recommendation. In July, the Committee also held an oversight hearing, at which time various advocacy groups as well as residents like Ms. Hemp testified in support of my bill. In Massachusetts, there are over 100,000 individuals aged 65 and older that have Alzheimer’s Disease. Roughly half of the residents in the Commonwealth’s 427 nursing homes have Alzheimer’s or a similar cognitive impairment. This bill is a simple and preventative measure that may save hundreds of lives. No family should have to go through the pain that Ms. Hemps’ family endured.