Physicians at the Durgin Pines nursing home in Kittery, Maine, had been concerned about the use of antipsychotic drugs for the facility's residents. When they pulled data from the pharmacy in July 2012, they found nearly a quarter of residents were being prescribed antipsychotics such as Risperdal. But most residents were receiving the drugs for reasons other than psychosis, such as to reduce agitation or stop aggressive behaviors.
“I have been frustrated by this for years,” said Dr. Jabbar Fazeli, a geriatrician who serves as medical director of the 81-bed for-profit facility. He says the rest of the nursing home staff was shocked.
In April 2005, the Food and Drug Administration issued an alert about the increased risk of death in elderly patients with dementia receiving antipsychotic drugs following a review of 17 trials that found increased risk of heart failure, sudden death and pneumonia.
A few months before Durgin Pines started its effort, a CMS public-private partnership on nursing home safety urged facilities to achieve a 15% reduction nationally in nonclinical uses of antipsychotic drugs. The CMS estimated that 39% of nursing home residents with cognitive impairment but no diagnosis of psychosis received antipsychotics between July and September 2010.