Nursing homes moving to use fewer drugs on dementia patients



Scripps Howard News Service

Long-term care watchdogs and nursing homes in Ventura County, Calif., are helping lead a national movement to reduce the use of powerful drugs to control the behavior of people with dementia, health officials say.

The use of antipsychotic drugs on nursing home residents in the county fell by 20 percent from 2010 to 2012, said attorney Tony Chicotel of the California Advocates for Nursing Home Reform, citing data from the U.S. Centers for Medicare & Medicaid Services.

The use of psychotropic drugs, a broader category medicine that can control the mind, emotion and behavior, fell 12 percent over the same period.

"Ventura County is an epicenter for this movement," Chicotel said at a symposium this week dedicated to alternatives to so-called chemical leashes. He cited the Medicare agency's goal to reduce the use of antipsychotics on Alzheimer's patients and others.

"What CMS is trying to prompt the nation to do, you've already done," he said. "What's going on here is remarkable."

Chicotel and others cited the education efforts of those who are finding ways to better understand and communicate with residents who have lost their ability to reason, and a growing awareness of studies stating antipsychotics can increase the risk of fatalities.

Deirdre Daly, administrator of an assisted living facility, Autumn Years at Ojai, Calif., said her emphasis is on better understanding the needs and backgrounds of her clients -- to the detail of knowing their tastes in music and books -- and using that knowledge to meet their needs. She said the barrier for some facilities to building such relationships is simple.

"It takes time and they have to focus on the medical," she said.

What needs to be done is to change the culture of a society where the benefits of pills are maximized and the risks are minimized, said Dr. Jonathan Evans of Charlottesville, Va., keynote speaker at the symposium and medical director for several nursing homes.

Evans, president-elect of the American Medical Directors Association, said health professionals shouldn't look at pills as a solution for patients who fight, wander or even urinate in potted plants outside their room.

If residents have dementia and believe they are living at home in the 1970s, don't try to force reality on them, Evans said. Don't try to change the mind of people who can no longer reason.

"Meet them where they live," he said, discouraging people from trying to force behavior change. "Tough love doesn't work with dementia."

He said often the most effective way to communicate with people who have dementia is not with medicine or words but with nonverbal communication that shows trust and respect.

He told of a nursing home that threatened the eviction of a resident with Alzheimer's because she kept pulling the facility's fire alarm. He suggested the reason was obvious: the sign told people to pull in case of an emergency.

"She thought she had done her good deed of the day. It said 'pull,' so she pulled it," he said, suggesting the solution was to somehow change the environment or at least add a new sign that said "not you, Ethel."

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