Atypical Neuroleptic Use in Nursing Homes Decreasing for the First Time This Decade

The class of drugs known as atypical neuroleptics has its basis in treating psychiatric disorders such as bipolar illness and schizophrenia, but for much of the past 10 to 15 years, these drugs have been used to treat elderly patients with dementia-related agitation and behavioral instability.

For the first six years of this decade (2000-2005, inclusive) their use by physicians in the nursing home setting has generally been increasing, from about 24% of all “eligible” patients to 32.5% in 2005.  That trend has appeared to reverse itself over the past twelve months as neuroleptic use dipped slightly to a rate of 31.9% for the first time.

I know that in my experience, during training in the mid-to-late 1990’s, the use of these agents for demented patients in the long term care setting grew at tremendous rates.  But something funny happened for many a physician on the way to the nursing home: the issue of an FDA black-box warning on this drug class and CMS regulatory efforts.

No doubt about it, there has been a great deal of knowledge gained about behavioral problems in demented institutionalized patients over the past ten years, and evidence of decreased reliance on these medications is all the proof one needs.

Physicians and institutions have adapted, utilizing specialized programs committed to safely controlling behavioral problems in this population without the need for drugs which do nothing but create a functionally dependent patient. | LINK