Safely Reducing the Off-Label Use of Antipsychotics in Assisted Living

The Issue

Nearly two out of five individuals in assisted living are living with some type of dementia. For these individuals and as illness progresses, behavior often becomes a key form of communication. This can be challenging for families and staff, and too often, antipsychotic medication is used in an attempt to modify behavior.

The use of antipsychotic medication to treat behavior associated with dementia is not supported clinically and is considered off-label by the FDA, which issued a “black box” warning for the elderly with dementia. They increase the risk of death, falls and fractures, hospitalizations, and other complications resulting in poor health and high costs. Additionally, antipsychotic drugs are expensive, costing Medicare hundreds of millions.

The intent of this Quality Initiative goal is to encourage alternative strategies for responding to challenging behavioral expressions in persons living with dementia before considering medications and to ensure that antipsychotic medications, when used, are as appropriate and safe as possible.

Ideas to Get Started

  • Start tracking your off-label use of antipsychotics with LTC Trend Tracker
  • Make sure staff understand dementia and the disease process
  • Implement consistent assignment, so that staff works with residents closely to understand preferences and communication methods
  • Look for non-pharmacologic interventions to enhance an individual’s quality of life
  • Help educate family members, health care partners, and other community members about the risks associated with off-label us of antipsychotics

Get other ideas from Granite Ledges in New Hampshire, which used a team approach to decrease off-label use of antipsychotics.



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Dementia Beyond Drugs:Changing the Culture of Care


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