Psychoactive Drug Misuse in Long-Term Care: Some Contributing Factors

Abstract

Surveys have identified inappropriate psychoactive drug prescribing patterns as a major problem in the care of nursing home residents. Residents without a documented history of mental illness often receive drugs intended to treat psychiatric problems. One of the greatest areas of misuse of these drugs is in the treatment of agitation in elderly demented residents. For example, although this purpose is likely the most common reason antipsychotic drugs are used in the nursing home setting, no well designed study has yet demonstrated that these agents are effective for this problem. Elderly individuals are particularly sensitive to the adverse effects of psychoactive drugs. Due to the gradual or insidious onset of some adverse effects, psychoactive drug toxicity may often be underestimated. The most serious example of a clinically underrecognized adverse effect of psychoactive drugs is tardive dyskinesia. Misinterpretation of certain nursing home residents' behaviors may lead to medication with tranquilizing drugs when other approaches may be safer and more effective. Excessive use of psychoactive drugs is not only physically harmful, but also encourages an apathetic attitude toward implementation of more humane ways of dealing with behaviorally disturbed nursing home residents.