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Wrong drug, wrong time, wrong place

Dear Reader,

I got the call last night. My grandfather is in a rehab hospital. He fell and broke his other hip, three years after the first.

He had surgery a week ago, but he was disoriented and didn't know my phone number or my sister's so no one alerted us.

When I finally tracked him down, the nurse told me he had been upset and yelling.

Of course he had! He's 94 years old. He's in pain, he's alone and he's disoriented.

Lucky for him, it stopped there because in too many situations like this one, the patient ends up in restraints and being forced to take a drug.

According to a new Health and Human Services report, the misuse of powerful antipsychotic drugs in assisted living facilities may be putting many lives at grave risk.

And specifically, anyone who has a loved one with dementia who's being cared for in a nursing home needs to know the three most shocking details uncovered by HHS.

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What goes on?
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In an article on CNN.com, Inspector General of HHS Daniel Levinson says that elderly residents in nursing homes are "too often" given antipsychotic drugs "in ways that violate government standards for unnecessary drug use."

That's shocking detail number one.

Number two: "Researchers found that 88% of the time, these drugs were prescribed for elderly people with dementia. This is precisely the population that faces an increased risk of death when using this class of drugs, according to the FDA."

It's bad enough these drugs were given completely inappropriately to patients who had no say in the matter, but the report also found that many patients continued to receive the drugs for too long and at dosages that were too high, in spite of black box warnings.

Which brings us to shocking detail number three: Government investigations of several drug companies found that they "improperly promoted their antipsychotic drugs for unapproved uses."

In one case, Eli Lilly actually pleaded guilty to criminal charges for illegal marketing of the antipsychotic Zyprexa. Part of that marketing included doctors who treated elderly patients in nursing homes.

Levinson adds that federal prosecutors charged Johnson & Johnson with paying millions in kickbacks to promote the antipsychotic Risperdal for treating nursing home patients.

At this point, drug companies ignoring patient safety to sell more drugs is about as common as a congressman caught with his pants down, but there's something about preying on patients who are so completely vulnerable -- the ones least able to speak up for themselves -- that brings this to a new low, even for Big Pharma.

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Is it really dementia?
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In his article, Levinson points out that family members have to be diligent on behalf of their loved ones in nursing homes -- constantly checking which medications are in use, how often they're used, a record of dosages, and potential side effects.

But what he fails to note is that these questions are just as important when a patient is first diagnosed with dementia.

As I've mentioned before, many adverse effects caused by drugs -- and especially interactions of multiple drugs -- are similar to dementia symptoms. Here's how one geriatric specialist puts it: Any new symptom in an older person should be considered a drug side effect until proven otherwise.

If you have a family member in a nursing home, you should familiarize yourself with "The Beers List of Potentially Inappropriate Medications in the Elderly." You can find the list on the website for the Duke Clinical Research Institute (dcri.org -- use search word "beers").

Keep in mind that new drugs are always entering the marketplace, so this list should be considered at least slightly outdated. For instance, Risperdal and Zyprexa are not on the list. Clearly, it's time to add them, especially in the case of dementia patients.

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