Psychiatric Drugs Often Misused in Rest Homes, Survey Concludes

Powerful tranquilizers that can cause dangerous side effects are being given to elderly people in rest homes, often by untrained aides without medical supervision, a Massachusetts study found.

Such drugs are available only with a doctor’s prescription, but many rest home residents continue to be given them months or years after a medical examination, the principal author of the report said Wednesday.

“It may well be that when they first started getting the stuff they needed it,” said Dr. Jerry Avorn of the Beth Israel Hospital and Harvard Medical School in Boston. “It may be that some people still need it,” he said, but without follow-up exams there is no assurance that a drug is being used properly.

Medications such as Thorazine and Haldol, designed for treatment of psychotics, can cause tardive dyskinesia, a disfiguring and sometimes irreversible side effect of uncontrollable facial twitches, he said.

Avorn said that use of such drugs is not being limited to treatment of psychoses.

“Sometimes they are used as sedatives, and that’s not a good idea, because they will have side effects that outweigh their advantages,” he said.

Too large a dose of a psychiatric drug also can aggravate confusion or lethargy, thereby increasing the risk that patients will fall and injure themselves, Avorn said.

Avorn, with Stephen B. Soumerai of Harvard and Paul Dreyer and Kathleen Connelly of the Massachusetts Department of Public Health, surveyed 55 rest homes in the state. The institutions care for elderly people who are not sick enough to be in nursing homes but are too frail to live on their own, Avorn said.

The findings were published today in the New England Journal of Medicine.