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December 4, 2007 at 15:20:33

DOCTORS PRESCRIBE ANTIPSYCHOTIC DRUGS FOR DEMENTIA IN NURSING HOMES

by Kenneth Briggs

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New York nursing home regulators find widespread misuse of antipsychotic drugs in nursing homes. America is facing a public health crisis over the care of those with dementia says Dr. Bruce Pollock, president-elect of the American Association of Geriatric Psychiatry. High use of antipsychotics in a nursing home can be an indicator of inadequate staffing. He says, we know the more staffing there is and the higher quality of care, the less the antipsychotic usage. We are left with the atypicals because we have nothing else. These drugs have a role to play, he says, but “nonpharmachologic treatments” should be tried first.

Dr. Jeffery Nichols, vice president for medical services at New York’s Cabrini Eldercare Consortium, a nonprofit group, says most dementia patients who become agitated are trying to communicate a deep-felt need or want. Dr. Nichols, who oversees a 240- bed nursing home, says that for dementia patients, antipsychotic drugs “don’t work very well and they are significantly overused.” The use of such drugs to care for agitated dementia patients is “like hitting a TV on the side.

The use of atypical antipsychotic drugs in nursing homes continues despite scientific papers that question the benefits of using them on dementia sufferers in light of the risks. Earlier this year, the federal Agency for Health Care Research and Quality reviewed existing research and noted the drugs can trigger strokes, induce body tremors, fuel weight gain and affect an elderly person’s gait, increasing their chances of falling.

The Food and Drug Administration issued a “black box” warning on using the drugs for dementia patients in 2005.But the FDA stopped short of banning such use; officials say they give physicians the leeway to prescribe the drugs if they think it will help this difficult-to-treat population.

Nearly 30% of the total nursing-home population is receiving antipsychotic drugs, according to the Centers for Medicare and Medicaid [CMS]. In recent years, Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals-including antibiotics, AIDS drugs or medicine to treat high-blood pressure. In a practice known as “off label” use of prescription drugs, patients can get these powerful medicines whether they are psychotic or not. CMS says nearly 21% of nursing-home patients who don’t have a psychosis diagnosis are on antipsychotic drugs.

Obviously something is needed to control the behavior of patients with dementia and even more obviously that something should not be antipsychotic drugs ;but according to the experts in the field it should be adequate staffing levels. Why then are billions spent on drugs rather than on staff? It seems to me that the federal and state regulatory agencies should be directed by the appropriate legislative bodies to immediately require appropriate staffing levels.

Source:

Lucette Lagnado, THE WALL STREET JOURNAL, December 4, 2007, page A1

 

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Born-03/20/1934, BA Pol. Sci.-U of Washington-1956, MBA-Seattle U-1970, Boeing-Program Control-1957-1971, State of Oregon-Mental Health Division-Deputy Admistrator-1971-1979, llinois Association of Community MH Agencies[IACHMA]-Executive Director-1980-1987, District of Columbia Government-MH Division-Chief MH System Development-1987-1989, Illinois Real Estate-Associate Broker-1989-1995, Ohio-Retired-1995-1999, Florida-Retired- 1999-?
Operate an eBay book store, Ajax Books Etcetera, which currently [12/17/06] has approx. 435 items for sale, mostly mystery books . Ajax Books Etcetera can be found by searching Google, Yahoo search and some other search engines. He has now found his true love;writing and consequently has joined the National Writers Association and the Society of Professional Journalists. Member Northwest Progressive Institute. Member Florida Progressive Coalition.

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John is a family physician in a small Iowa rural community. He is happily married, the father of two children, and active in his Christian church. His hobbies include photography and tinkering with computers. His passions are philosophy, science, and the incredibly critical point in the space-time continuum that is Now.
John BoweryJohn is a family physician in a small Iowa rural community. He is happily married, the father of two children, and active in his Christian church. His hobbies include photography and tinkering with computers. His passions are philosophy, science, and the incredibly critical point in the space-time continuum that is Now.

Easy to be critical of people with a difficult problem.

As a family physician who helped treat patients in a geriatric psychiatry hospital, I can see why the public and more than a few doctors are critical of the care our elderly demented patients receive. Many primary care physicians over utilize anti psychotics and under utilize diagnostic skills in treating agitation. Unfortunately, it is far easier to identify the problem than it is to solve.

Years ago legislators (spurred on by witch-hunting journalistic exposes) virtually eliminated the "barbaric" practice of using physical restraints to secure hospital patients and residents in nursing homes. Now the fad is to bash doctors for using "chemical straight jackets" to accomplish the same thing. At the same time nursing homes face stiff fines if a confused patient removes a motion alarm and falls or assaults another resident. Everyone knows that given enough trained staff that most of these people can restrained or redirected humanely. But no one wants to pay more than minimum wage for what is frankly a difficult and distasteful job. Maybe if the academicians, legislators, and reporters spent a few days changing diapers, dodging spittle, and listening to profanity they would be a little less glib in their critiques.

by John Bowery (0 articles, 0 quicklinks, 0 diaries, 20 comments) on Tuesday, December 4, 2007 at 7:25:03 PM
 


Born-03/20/1934, BA Pol. Sci.-U of Washington-1956, MBA-Seattle U-1970, Boeing-Program Control-1957-1971, State of Oregon-Mental Health Division-Deputy Admistrator-1971-1979, llinois Association of Community MH Agencies[IACHMA]-Executive Director-1980-1987, District of Columbia Government-MH Division-Chief MH System Development-1987-1989, Illinois Real Estate-Associate Broker-1989-1995, Ohio-Retired-1995-1999, Florida-Retired- 1999-?Operate an eBay book store, Ajax Books Etcetera, which currentl...

to see more of bio, click on member name

Kenneth BriggsBorn-03/20/1934, BA Pol. Sci.-U of Washington-1956, MBA-Seattle U-1970, Boeing-Program Control-1957-1971, State of Oregon-Mental Health Division-Deputy Admistrator-1971-1979, llinois Association of Community MH Agencies[IACHMA]-Executive Director-1980-1987, District of Columbia Government-MH Division-Chief MH System Development-1987-1989, Illinois Real Estate-Associate Broker-1989-1995, Ohio-Retired-1995-1999, Florida-Retired- 1999-?Operate an eBay book store, Ajax Books Etcetera, which currentl...

to see more of bio, click on member name

Glib?

I'm sorry if I seem glib in attempting to identify the problem in treating patients with dementia. I thought that I was pretty clear in identifying the solution to the problem-its staffing. As staffing is increased, drug use goes down. So let's shift some of the funding away from drugs and toward staffing. And I believe there's sufficient money going unnecessarily to drugs that something more than minimum wage could be paid to nursing home caregivers. Of course, I have only about 20 year's experience dealing with persons who are mentally ill and/or suffering from dementia so I'm sure there are those who have more experience in dealing with these problems and have answers that are less glib. What are your answers?

 

by Kenneth Briggs (125 articles, 88 quicklinks, 2 diaries, 108 comments) on Tuesday, December 4, 2007 at 8:03:42 PM
 

 

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