Medication for Long-Term Care Residents: Reducing Overuse Without Compromising Access and Care

By David Charles, MD and Mary Ann Chapman, PhD

More than 2 million elderly Americans live in long-term care settings such as nursing homes. Residents of these facilities take an average of nine different medications each day, with the most common being medications for digestive problems, psychological symptoms, and pain. In 2011, 24% of residents in US longterm care facilities were taking antipsychotic medications. Medicare Part D paid $7.6 billion for antipsychotic medications in 2011, which was the second highest amount spent on any class of drugs. Over the past five years, several pharmaceutical companies have inappropriately marketed their antipsychotic medications for use in older adults with dementia, in one case resulting in more than $2.2 billion in fines—the third-largest pharmaceutical settlement in US history.

Antipsychotic medications in patients with dementia can cause adverse side effects, such as increased risk of stroke, falls, sedation, metabolic changes, and movement problems. Moreover, these medications have been linked to an increased risk of death in patients with dementia. In 2007, 88% of claims for a subgroup of antipsychotic medications known as the atypicals for elderly nursing home residents were actually for patients with dementia, although the FDA specifically warns that these medications are associated with an increased risk of death in this population.

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