Reducing Off-Label Antipsychotic Use in Older Adults: Time to Look Beyond the Doors of Nursing Homes

Abstract

The vexing problem of off‐label use of antipsychotics in nursing homes continues to challenge the industry. Food and Drug Administration black box warnings in 2005 and 2008 about the serious adverse effects of offlabel use of antipsychotics in older adults had little effect on the prevalence of antipsychotic use in nursing homes.1 The 2011 Department of Health and Human Services Officer of Inspector General report noted that 83% of Medicare claims for atypical antipsychotic drugs for nursing home residents were associated with off‐label conditions and 88% with dementia.2 In response, the Centers for Medicare and Medicaid Services (CMS) launched a national initiative to reduce atypical antipsychotic use in nursing homes.3 The partnerships and other administrative initiatives are working, with a 35% relative reduction in the use of antipsychotics in nursing homes since the launch of the initiative (from 23.9% in fourth quarter 2011 to 15.5% in second quarter 2017).4 As new, ambitious targets for reductions in off‐label antipsychotic use are set for nursing homes, the Government Accountability Office has called for expansion beyond nursing homes to other settings.5 In this issue of the Journal of the American Geriatrics Society, Zhang and colleagues6 provide novel data to inform expanded efforts by evaluating where antipsychotics prescribed in nursing homes were first initiated.