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Overmedicating Our Elders

According to a survey conducted by Consumer Reports, you may be in the minority if you don't regularly take a prescription drug. In a sample of nearly 2,000 American adults, more than half regularly took prescription medications and the average adult took four. The total number of prescriptions filled by Americans increased by 85 percent from 1997 to 2016. However, the total population increased by only 21 percent during that same period.

Every age group is at risk for being diagnosed with a condition they may not actually have, and subsequently being prescribed medications they do not need. Many choose an over-the-counter (OTC) or prescription medication to feel better. You might assume that  are safe, but availability does not equate to being risk-free. Some current OTC medications were once available by prescription only.

In an increasingly litigiousness environment, and under a very real fear of medical malpractice lawsuits, physicians often feel pressured to prescribe medications designed to relieve symptoms, but not seek the foundational cause of your condition. When physicians do not follow published standards of care and instead seek to provide individualized care to their patients, they may be publicly criticized by colleagues and potentially rebuked by their professional organization.

One group of individuals who are at high risk of receiving prescription medications for diseases or illnesses they do not actually have are nursing home residents who suffer from .

Alzheimer’s disease Changes Cognition and Behavior

 is a progressive and irreversible neurological disorder that slowly destroys memory and cognitive functioning. Eventually, the individual is unable to carry out even some of the simplest tasks and cannot remember people in their lives who were once very important. Although estimates vary, many experts suggest that more than 5 million Americans may have Alzheimer's disease and it is currently ranked as the sixth leading cause of death in the United States.

Some of the first signs of Alzheimer's disease and other forms of dementia are memory problems. Early symptoms do not often interfere with everyday life, but as the disease progresses, symptoms continue with a decline in cognition and impaired reasoning or judgment. Ultimately, changes occur throughout the brain leading to difficulty communicating and a complete dependence on others.

In a study published in Cognitive and Behavioral Neurology, researchers concluded patients with Alzheimer's disease experience emotions that persist well beyond their memory of what happened to cause the emotion. This has important implications in management and care, and may offer an explanation for behavioral changes that occur as the disease progresses.

Alzheimer’s disease can trigger sudden  or behavior for no apparent reason, and changes in personality, including extremely confused, suspicious or fearful behavior. These emotions lead to significant changes in behavior, during which individuals may become violent or attempt to flee their environment.

Chemical Restraints Increase Risk of Death

In an effort to control difficult behaviors common with dementia and Alzheimer’s disease, it has not been uncommon for physicians to prescribe antipsychotic drugs to individuals in nursing home facilities, even when there is no diagnosis of schizophrenia or other serious mental illness for which these drugs are intended. In essence, the medications are being used as a chemical restraint.

In a 2018 study published by the Human Rights Watch, researchers found approximately 179,000 nursing home residents were being given antipsychotic drugs with the intent to control their behavior. Although the use of antipsychotic drugs has dropped by approximately 30 percent since 2012 when the government began a national partnership with nursing homes to reduce the use, a significant number of residents continue to receive  for which there is no medical cause.

Medicare and Medicaid Services have requested an additional 15 percent reduction by 2019, but Human Rights Watch contends this is not nearly enough. The study also strongly suggests informed consent procedures should be strengthened and nursing homes should have established minimum staffing levels in order to reduce the use of sedation to make it easier for the staff.

While the need to reduce risk of harm to an individual with dementia is real, the use of antipsychotic medications comes with a black box warning from the U.S. Food and Drug Administration (FDA), stating: “Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.”

The Alzheimer’s Association suggests drugs to control behavior needs to be minimized, and only be used when the patient is at risk of harming themselves or others. The dosage should also be tailored to the individual’s symptoms and circumstances, and the physician must account for the underlying medical cause of dementia, as this may influence the selection of any medications chosen.

For instance, it is inadvisable for individuals with dementia with Lewy bodies (abnormal proteins inside nerve cells of Parkinson’s patients) to take antipsychotic drugs.