The Un-drugging Our Elders

Posted on December 26th, 2007 by AGIS Staff

Last week we featured a story on how long-term care facilities were excessively using anti-psychotic drugs to sedate elders with Alzheimer’s and dementia. Despite warnings from the Food and Drug Administration that many of the types of antipsychotic drugs used increase the risk of injury, or even death, for elderly dementia sufferers. According to the Centers for Medicare & Medicaid Services (CMS), about 30% of nursing-home residents are on antipsychotic drugs, and most were on newer drugs called atypical antipsychotics. Atypical antipsychotics are approved for schizophrenia and bipolar disorder only, but for what is known as “off label” use, doctors often prescribe the drugs to elderly people with dementia.

However, according to an article in the Wall Street Journal, many facilities, such as Cobble Hill nursing home in Brooklyn, NY, are now attempting to wean their residents off of antipsychotics. Instead of drugs, when patients get upset or distressed, the staff at Cobble Hill have found the best way calm them down is to engage them in activities, giving residents a renewed sense of purpose. By utilizing a form of environmental redirection they have found that even the simplest tasks, such as setting the table, can help redirect a patient’s energies for positive outcomes.

At Providence Rest Nursing Home in the Bronx, distraught Alzheimer’s patients are given massages and aromatherapy. Providence, a facility with 200 patients run by an order of nuns, has brought its overall reliance on antipsychotics down to 2% over the last few years — and down to zero among patients who are not psychotic. At Bishop Wicke Care Center, a 120-bed facility in Shelton, Conn., the emphasis is on giving patients consistent caregivers – avoiding the staff turnover that can make life trying for residents. The home has also undertaken a project to get to know what patients were like when they were young, as a key to dealing with their angst.

Unfortunately, some patients with forms of dementia, such as Alzheimer’s, aren’t as responsive, and it is a constant struggle for caregivers. William Thies, a vice president at the Alzheimer’s Association in Chicago, is also quick to point out that these solutions do not work with every patient and, in those cases, these drugs may still need to be used. But the drugs need to be used very carefully, at the lowest dose and after ruling out a medical problem, says Dr. Thies, who has a doctorate in pharmacology.

Several forms of antipsychotic medicines have proven to reduce outbursts for Alzheimer’s and dementia patients — behavior that can overwhelm family members trying to care for a loved one at home, and strain the resources of those trying to maintain order in largely understaffed facilities.

The ethics of using antipsychotic drugs has recently heated up, and even politicians are getting involved. Just this month, Senator Charles Grasley, the ranking Republican on the Senate Finance Committee, asked several drug manufactures for records on how they may have marked these drugs for use in geriatric patients. He has also asked the Inspector General of the Department of Health and Human Services to investigate drug use in nursing homes.

And the problem is not going to get any easier in years to come. According to a recent Alzheimer’s Foundation of America estimate, nearly half of all Americans are at risk of acquiring Alzheimer’s disease after age 85 and the challenge of caring for rising numbers of seniors who suffer from dementia and the behavior problems that can stem from it has provoked a heart-wrenching debate among nursing-home operators, regulators and families.

Despite these difficulties many believe the right solution is to turn from antipsychotics and try alternatives to help those suffering from Alzheimer’s and dementia.

Dennis Smith, director of the Center for Medicaid and State Operations, says care facilities should seek “a different model” of care, so that when dealing with patients in distress, the solution isn’t only “unlocking the drug cabinet.”

Resources from AGIS.com:

Alzheimer’s and Dementia Section

Behavioral Issues Related to Alzheimer’s and Dementia

Alzheimer’s Disease