Misused Antipsychotic Drugs

Government finds nursing homes misuse antipsychotics -


Last evening on the CBS Nightly News,  Armen Keteyian reported on a longstanding problem at nursing homes.

This problem actually goes back for years and years, but as the type of drugs used to chemically restrain elderly people in these centers, problems are much more severe.

ABC Evening News reported on a similar issue in California in 2010.

Even before this, I reported on it because my brother, a METLife sales rep in Colchester VT and South Hero VT, outside Burlington, allowed this to happen to my mother.

In 2003 I spoke against the 7 drugs forced on my mother at Bentley Care Center in Naples FL, owned by Hyatt Corporation.

One of the drugs reported on in last night's news was Zyprexa.  My mother was forced to take Zyprexa.  This drug is NOT recommended for elderly, especially elderly women, because of the long half-life.

The Case of a Sequestered Mind

What was reported last evening referred to the 2005 Black Box warnings for these drugs.

The report by the Health and Human Services inspector general also found that antipsychotic drugs were given to nursing home residents "unnecessarily" over 300,000 times between January and June 2007, with more than half of those drugs (150,106) given "in excessive dose."

"The use of anti-psychotic drugs when they are not necessary is a form of restraint," said Dr. David Zimmerman, University of Wisconsin. "It's a form of chemical restraint."

The Department of Health and Human Services also says it's "very concerned" that there are "financial incentives for unnecessary drug use." In the past those incentives have led to charges of "kickbacks" between nursing homes, pharmacies and a drug company.

http://www.cbsnews.com/stories/2011/05/09/eveningnews/main20061257.shtml 

The newer class of drugs, atypical antipsychotics, such as Zyprexa (Eli Lilly & Co.) and Risperdal (Johnson & Johnson), already received the stronger warning labels in 2005, alerting the public about the potential for heart attack and pneumonia when given to the elderly.

In my mother's situation, she did not have dementia, at least initially.  Over drugging may have caused this to develop but Hyatt was not very forthcoming with information, except to say that if she was taken off the polypharmacy cocktail she would have to be moved to another facility.

Having been a Director of Nursing in several facilities I am well aware of the issues and the hair on the back of my neck rose every time I heard a new excuse from the Bentley DON.  It only showed she was willing to shut up for a pay check and not act to protect patient safety.  


This clearly links to the issue of financial incentives to nursing homes and Big PhRMA kickbacks.


What was also strange was that they had no drug interaction profile for the drugs.  The DON offered the excuse that their pharmacy did this. However, they would not identify the pharmaceutical supplier of their drugs, or supply me with any related data.

What was worse is that my brother refused to see that my mother had proper care.  He would not take her to a Naples neurologist I recommended because he would have to spend money to do so.  He also refused to accept the information I provided him that came from a top psych drug researcher (PhD RPh) at FDA, and a colleague of mine.

Later she had a fall and suffered a fractured hip.  A common side effect of over drugging the elderly. I suspect diabetes but Bentley failed to honor my access to information in the last years of my mother's life.

And to my brother, I am the bad sister who causes trouble.

I contacted the ABC affiliate in Naples after a story on a similar topic was aired in 2010.  They showed no interest in this story.  Their interest was in litigation.

Clearly, these drugs were not necessary in my mother's care.  More likely, they were given in excessive doses.

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Posted in: Armen Keteyian,Care Center,Hyatt,John Bourland,Naples Fl,Zyprexa

Call to end exclusion of elderly from drug trials

This news story caught my eye because I have become concerned about this very issue over the past six or seven years. In my way of thinking it is important to set up specific drug trials not just for Elders but for children and women too.

In 2003 my mother suffered a closed head injury, and as a result of her fall and the TBI she developed expressive aphasia.

Expressive aphasia is condition  and an acquired disorder of language due to brain damage. Most aphasias and related disorders are due to stroke, head injury, cerebral tumors, or degenerative diseases.  People may lose the ability to produce speech, to comprehend speech, to repeat, and to hear and read words in many nuanced ways. Language difficulties can also be affected by pharmaceutical drugs often over used in faculties that care for Elders.

Speech and language therapy is the mainstay of care for people with with aphasia. The timing and nature of the interventions for aphasia vary widely. Blinded studies are limited, and recovery of many degrees is expected.  Studies also indicate that speech and language therapy does improve clinical outcomes in aphasia, but individualized programs are important. 

The potential for functional recovery from primarily expressive aphasia after stroke is excellent. A neurologist should be key in evaluation and care, as well as speech therapy.

After her injury, my mother was placed in a 5 Star facility in Naples, Florida.  She was loaded up with an over abundance of psychotropic drugs, including  Zyprexa, yet did not have a neurologist or speech therapy prescribed.

Zyprexa is questionable for the elderly, especially for use in elderly women, and it can precipitate diabetes.  The case in point is that regardless of the number of drugs prescribed, and failure of the center to evaluate the drugs for interaction, no one except me questioned the use of this drug in my mother's care.  Zyprexa has an unusually difficult time being excreted by older women and as a result has a longer half-life.

Another drug being given to my mother, not prescribed by a neurologist, was Neurontin, and it is implicated in the development of impaired speech. And yet another one of the several SSRIs perscribed has a known side effect of suicidal thinking.  My mother tried to jump out of a window.  The outcome: more drugs to sedate her further.

The house psychiatrist diagnosed my mother as depressed.  Yet when I asked how he diagnosed her with the aphasia, he could not answer.  He just prescribed more drugs.

I contacted a colleague in the pharmaceutical research section dealing with psychotropic durgs at the FDA for an opinion on the list of drugs prescribed to my mother.  He was shocked, and especially noted the severe issues indicated by the drug interaction profile.

The care center supplying pharmacy never conducted a thorough interaction profile. 

The attending GP, a whining DO from a near by town, most likely interested in the Medicare reimbursement more than my mother's condition, whined to my brother after I talked with him, saying he did not like the questions I was asking.

The director of nursing threatened forced relocation if my mother was taken off any of the drugs.  Since the bill went to Medicare I am sure reimbursement was more the concern than my mother's well being.  And of course there is the issue of staff convenience.

Well, my mother died last summer.  She won't be forced now to take any more drugs, but for six years which must have been agonizing for her, she was over drugged and could not communicate.

My little brother, who held POA, a player in the insurance/finance business, made absolutely no effort to see that my mother was taken to a nationally recognized neurologist in Naples.  Nor would acknowledge my concerns over the drugs and her treatment.  He failed to get her even the most clearly established care for  the aphasia, but was concerned over the cost of the drugs.

He also failed to tell the care center that my mother had a daughter, and didn't make any effort to contact me about this incident until three months after it happened.

Read the complete areticle here - http://news.bbc.co.uk/2/hi/health/8487509.stm

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Posted in: apasia,drug interactions,drug trials for the elderly,drugs and the elderly,Elder care,Medicare fraud,Naples Fl,over drugging the elderly