One Pill Makes You Taller, the Other Makes You Small – The Over-use of Anti-Psychotics in Nursing Homes

This series is intended to help Key therapists deal with the changes that are likely with the new Medicare push to reduce the amount of anti-psychotic medications in nursing homes. Estimates of rates of use range from 27% to 40%. This sounds high, but consider what anti-psychotics were designed for…can you guess? Right, treating psychosis!

What is psychosis? Either delusions (“I am being poisoned…spied on…abducted by aliens”) or hallucinations (“I see aliens…hear commands to do things…smell rotting things…feel people touching me”). Being confused is not psychosis (“It is 1940…You are my father…we are in France…I have to get home to feed the children”).

The over use of anti-psychotics starts looking crazy when you see studies that find that only 2% of nursing home residents have schizophrenia (the primary diagnosis warranting the use of anti-psychotics), and the rate of all types of psychosis runs about 10%.

So why all the fuss? Anti-psychotics in the demented elderly doubles their risk of heart attack or stroke. They are sedating drugs. They are expensive, costing Medicare about $13 billion per year. They increase the risk of falls and pneumonia.

How did it get like this? Stay tuned for the next exciting episode!