by Amanda Conschafter, blog editor
Medications treating mental illness symptoms in elderly patients have become widely used –sometimes overused – in long-term care facilities. Concerns about side effects and even possible death for elderly patients prompted the Centers for Medicare and Medicaid Services last year to recommend reducing the medications’ use. But in a newly released policy brief, the Institute for Patient Access notes that these medications in their approved uses can be effective for certain patients. Therefore, policy responses must be balanced, argues “Medication for Long-Term Care Residents”—and allow physicians, patients and their families to make personalized decisions about treatment options.
More than 2 million elderly Americans live in long-term care settings, the brief notes, and 24% of them take antipsychotic medications. But while some patients battling Alzheimer’s and Parkinson’s diseases do exhibit symptoms such as psychosis, antipsychotic medications can cause side effects. In patients with dementia, for example, the medications carry an increased risk of stroke, falls and even death.
CMS’ Proposed Rule
CMS’ “Reform of Requirements for Long-Term Care Facilities” responds to these risks. The proposed rule recommends that long-term care residents gradually reduce their doses, moving toward discontinuing the medications altogether. But a one-size-fits-all approach may not be the best move for patients, the policy brief argues. Patients with Alzheimer’s and Parkinson’s frequently face psychological symptoms, and behavioral and cognitive therapies may not work for all patients. Certain patients, such as dementia patients with severe psychological symptoms, may benefit from antipsychotic medications and similar drugs.
Finding a Balance
Ultimately, the brief emphasizes, decisions about medication and dosing belong to the health care provider, the patient and the patient’s family. Therefore, policymakers and CMS should consider an exception from dose reduction requirements when the medication is approved by the FDA for the condition it is being used to treat. And health plans should maintain access for patients whose physicians determine could benefit from these therapies.
These medications can and do help some patients, the brief explains, and those patients shouldn’t be overlooked by regulators and policymakers as they work to shield elderly patients from harm.