Psychotropic drugs given to nursing home patients without cause
Many Illinois residents get medications they don't need or want. The result? A threat to the lives of our elderly.
One home tried to give the antipsychotic Seroquel for 16 days to a man with no psychotic symptoms. He kept saying no, but on the 17th day, a nurse gave it to him without saying what it was. The Tribune found 600-plus instances of residents given psychotropics without consent. (Tribune photo by José M. Osorio / July 30, 2009)
Thousands of elderly and disabled people have been affected, many of them drugged without their consent or without a legitimate psychiatric diagnosis that would justify treatment, state and federal inspection reports show.
Lloyd Berkley, 74, was in a nursing home near Peoria for less than a day before staff members held him down and injected him with a large amount of an antipsychotic drug, according to a state citation. A few hours later he fell, suffering a fatal head injury.
One woman was given a psychotropic drug partly because she refused to wear a bra. Nursing home staff administered an antipsychotic medication to an 87-year-old man because he was "easily annoyed."
In all, the Tribune identified 1,200 violations at Illinois nursing homes involving psychotropic medications since 2001. Those infractions affected 2,900 patients.
The actual numbers are likely far higher because regulators inspect some facilities just once every 15 months, and even then they usually check only a small sample of residents for harm.
The Tribune's unprecedented review of more than 40,000 state and federal inspection reports found that nursing homes ranging from "five-star" establishments on the North Shore to run-down facilities in urban neighborhoods have been cited for improperly administering psychotropic drugs.
The paper's review took into account violations for "chemical restraint" and "unnecessary drugs" as well as cases involving dosages that exceeded safety standards or falls in which psychotropics possibly played a role.
While some nursing home residents suffer from major mental illnesses, such as schizophrenia, the inspection reports show that many patients harmed by antipsychotic drugs had not been diagnosed with psychosis. They were disabled by Alzheimer's disease, cancer or Parkinson's disease. Some were blind or so frail that they could not breathe without the aid of an oxygen tank.
The findings come at a difficult time for Illinois nursing homes, which are already under fire for housing violent felons alongside geriatric patients and for failing to accurately assess the risk posed by the most serious offenders.
The misuse of psychotropics, which some experts say is a nationwide problem in nursing homes, suggests a troubling future for many seniors. The Tribune found 12 patients, including Berkley, whose deaths led to nursing home citations involving misuse of psychotropics.
In testimony before Congress two years ago, Food and Drug Administration scientist Dr. David Graham estimated that thousands of nursing home residents die each year because antipsychotic drugs are administered to patients who are not mentally ill. Graham is known for blowing the whistle on Vioxx, the painkiller tied to heart attacks, but his warning on the psychotropics issue has drawn little attention.
New York researcher Christie Teigland, who is analyzing medical data on 275,000 nursing home residents with dementia, said she is finding that those on psychotropic drugs were more likely to fall or experience general decline than others.
When taken off the medication, the patients improved, she said.
"These residents come alive," said Teigland, of the nonprofit New York Association of Homes & Services for the Aging. "It's like they become functional individuals again."
Easier to deal with Inspection records show that hundreds of nursing home residents in Illinois displaying no psychotic symptoms have been placed on antipsychotic medications for such reasons as "restlessness," " anxiety" or "confusion."
Why? Often, it's to make them easier to care for, the records show.
Some health care workers defend the use of psychotropics in nursing homes, saying they help patients, particularly those with Alzheimer's disease and other forms of dementia, live happier and more independent lives.
But the medications can be extremely dangerous. The most commonly used antipsychotics carry so-called black-box warnings, the FDA's highest advisory. Side effects may include severe lethargy, permanent involuntary muscle movements, seizures and sudden death.