Harvard Mental Health Letter

In Brief: Antipsychotics are overprescribed for nursing home residents

A federal audit of Medicare claims for elderly nursing home patients has concluded that more than half of the prescriptions for second-generation "atypical" antipsychotics were written in error — meaning they did not meet FDA or professional organization prescribing guidelines. The audit also found that nearly 90% of antipsychotics in nursing homes were prescribed for patients with dementia, in spite of a "black box" warning (the strongest type of advisory) that such drugs can be deadly in this population.

Atypical antipsychotics include aripiprazole (Abilify), olanzapine (Zyprexa), and risperidone (Risperdal). The drugs are FDA-approved mainly for the treatment of schizophrenia and bipolar disorder. Like all drugs, however, antipsychotics are sometimes prescribed "off label" for other uses such as depression, obsessive-compulsive disorder, and post-traumatic stress disorder.

The U.S. Office of Inspector General conducted the audit at the request of Senator Chuck Grassley of Iowa, who has targeted the influence of drug companies — particularly makers of psychiatric drugs — in medicine. The government auditors examined 2007 Medicare claims data for nursing home residents ages 65 and older.

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