From the U.S. Government Accountability Office, www.gao.gov Transcript for: Federal Efforts to Reduce Antipsychotic Drug Use Description: Audio interview by GAO staff with Katherine Iritani, Director, Health Care Related GAO Work: GAO-15-211: Antipsychotic Drug Use: HHS Has Initiatives to Reduce Use among Older Adults in Nursing Homes, but Should Expand Efforts to Other Settings Released: March 2015 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. It's March 2015. Dementia affects millions of older adults, causing behavioral symptoms such as mood changes, loss of communication and agitation. Antipsychotic drugs are sometimes used to treat these symptoms in older adults even though the Food and Drug Administration has not approved them for this use. In fact, FDA has warned using antipsychotic drugs for these cases may cause an increased risk of death. A team led by Katherine Iritani, a director in GAO's Health Care team, recently reviewed federal efforts to reduce the use of these drugs among older adults. GAO's Jacques Arsenault sat down with Katherine to talk about what they found. [ Jacques Arsenault: ] What are antipsychotic drugs and how frequently are they prescribed for older adults? [ Katherine Iritani: ] Antipsychotic drugs are a powerful type of drug that are often prescribed for mental health conditions. They are relatively frequently prescribed in the older adult population. In looking at Medicare Drug data, we found that about 1 in 3 older adults with dementia and nursing homes was prescribed antipsychotics and outside of nursing homes this rate was about 1 in 7. One would expect to see a higher rate in a nursing home given the severity of illness is often higher in nursing homes, but these drugs are pretty powerful and they are not FDA approved for treating this condition of dementia and are associated with a higher risk of death and have other side effects. [ Jacques Arsenault: ] So then, given the risks of these drugs why are they so commonly used in nursing homes? [ Katherine Iritani: ] Well, physicians are not prohibited from prescribing these drugs for dementia despite the box warning. The factors contributing to prescribing are complex. There maybe concerns that an individual has symptoms such as aggressiveness or agitation that raises concern that they may harm themselves or others. There may be caregiver concerns that they cannot take care of a person in the home or in a setting without prescribing of these drugs. There are other factors that are less related to patient's conditions. Experts have told us that the culture of the nursing home, for example, that some nursing home managers may encourage the use of the drugs, that the level of staff training and education that may be associated with prescribing that some staff may not be aware of the risk of the drugs or have nondrug alternatives they can try. We also heard from experts that antipsychotics are often initiated in hospitals and then carried over to other settings such as the nursing home. [ Jacques Arsenault: ] Let me ask you then, what is the federal government doing to reduce the use of these drugs? [ Katherine Iritani: ] Oh, HHS has a number of initiatives focused on reducing antipsychotic drug use. Particularly for individuals in nursing homes. There is a national plan to address Alzheimer's disease, which is a form of dementia and under that HHS has a goal to monitor, report, and reduce the use of these drugs in nursing homes. The Centers for Medicare and Medicaid Services is conducting outreach and training and working with state-based coalitions and consumer advocates to educate and promote appropriate dementia care in nursing homes and CMS has also trained their state surveyors that review the care of individuals in nursing homes on appropriate dementia care and unnecessary use of these drugs. There's also a federal government system for rating nursing home quality, which starting this year, will include antipsychotic drug use in the measure. [ Jacques Arsenault: ] So then, what recommendations is GAO making to HHS to improve on these efforts? [ Katherine Iritani: ] We found that there are a lot of initiatives underway to reduce antipsychotic drug prescribing in nursing homes, but we didn't find a lot of focus on the rate outside of nursing homes. So our recommendation to HHS is to develop a strategy to expand its education and outreach efforts to reduce drug use of antipsychotics and studies outside of nursing homes. [ Jacques Arsenault: ] Finally, what would you say is the bottom line of this report? [ Katherine Iritani: ] So, this is a complex issue with no simple answers and hopefully this report will bring more attention to prescribing that is occurring both within and outside of nursing homes. There are risks to individuals with dementia who take these drugs, but there are benefits of managing the symptoms that may outweigh these risks, and there's general recognition, though, that the prescribing rates are too high. [ Background Music ] [ Narrator: ] To learn more, visit GAO.gov and be sure to tune in to the next episode of GAO's Watchdog Report for more from the congressional watchdog, the U.S. Government Accountability Office.