I've written here several times before, from my perspective as a Philadelphia medical malpractice lawyer, about the use and overuse of atypical antipsychotics in nursing home patients. Although antipsychotics are not approved for use in controlling dementia symptoms, nursing home staff members use them for this purpose anyway because they believe it helps control difficult or violent behavior. However, research over the past few years has found that atypical antipsychotics -- the drugs most often used for this purpose -- increase risk of death in elderly and demented patients, which has led to a dramatic drop in their use. Now, a new study published in the Canadian Medical Association Journal finds that typical antipsychotics, which may be used as an alternative, are no better.
The study was conducted using nursing home records for 10,900 patients in British Columbia. Scientists looked at all psychotropic drugs for patients 65 and older admitted to nursing homes between 1996 and 2006. That included roughly equal proportions of patients getting atypical and typical antipsychotics, as well as even more patients receiving antidepressants or benzodiazepines. After looking at outcomes for each class of patients, the researchers concluded that there was actually a lower risk of death for users of atypical antipsychotics than for patients in the other three categories. A geriatric psychiatrist from the University of Rochester, who was not connected to the study, said it was well designed, but more research was needed before doctors should change their prescribing practices.
As a Pennsylvania nursing home lawyer, I'm disturbed by these conclusions, because they suggest that no psychiatric drug is especially safe. Use of atypical antipsychotics has dropped since they got a black box warning about death, but it looks as if the clearest alternatives, older antipsychotics, carry at least an equal risk. That's unfortunate because nursing homes frequently use them -- in my opinion as a Pennsylvania injury lawyer, overuse them. Using drugs to control dementia patients' behavior may be tempting, especially for homes that have cut staff to save money and don't have the resources to handle difficult patients. However, these "chemical restraints" also leave them in a drugged state and puts them at risk of death and serious illness. I believe this is a form of Pennsylvania nursing home abuse, and families that have suffered an injury as result should hold them legally responsible.