Are senior citizens being overmedicated? – The Chart - CNN.com Blogs

Strong, antipsychotic drugs are being prescribed more often to senior citizens in U.S. nursing homes, setting off a debate about whether it's the right treatment for the elderly suffering from dementia.

Daniel Levinson, inspector general for the Department of Health and Human Services, believes this increase - detailed in a recent study by his office - is a cause for alarm.  "The report found that too often, elderly residents are prescribed antipsychotic drugs in ways that violate government standards for unnecessary drug use," he wrote in a commentary for CNN.com.

Psychiatrist Daniel Carlat disagrees, saying the study Levinson cites is a "blizzard of statistics" that doesn't tell the entire story.  "When these drugs are successful, they soothe the inner turmoil that makes life intolerable for these patients, improving their quality of life dramatically," Carlat wrote in his commentary for CNN.com.

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Alzheimers Disease, Dementia & Senility, Direct (Bedside Nursing) Patient Care

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See also:

• Related: Alzheimers Dementia, Caregivers, Caregiving, Certified Nursing Assistants, CNAs, Geriatric Associations, Nursing Homes, Long Term Care

• Prescription Medications: Cognex, Tacrine, Exelon, Rivastigmine, Reminyl, Galantamine, Requip, Ropinirole

Alzheimer's Association:"The Alzheimer's Association is your source for information, support and assistance on issues related to Alzheimer's disease.
The Alzheimer's Association National Headquarters, 919 N. Michigan Ave., Suite 1000, Chicago, IL 60611-1676
Call us at (800) 272-3900
http://www.alz.org/

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Alzheimer's Disease Education and Referral (ADEAR) Center:"The ADEAR Center is a service of the National Institute on Aging (NIA). The NIA is one of the National Institutes of Health under the U.S. Department of Health and Human Services."
Postal mail:
PO Box 8250
Silver Spring, MD 20907
Phone: 1-800-438-4380
Fax: 1-301-495-3334
http://www.nia.nih.gov/alzheimers/

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Alzheimer's Society - about dementia...

The Alzheimer's Society is the leading UK care and research charity for people with dementia, their families and carers. This site is frequently updated with leading information appropriate to the Soc...
http://www.alzheimers.org.uk

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Alzheimer's Disease Research, American Health Assistance Foundation (AHAF):"Alzheimer's disease is a progressive, irreversible brain disorder with no known cause or cure. It attacks and slowly steals the minds of its victims. Symptoms of the disease include memory loss, confusion, impaired judgment, personality changes, disorientation, and loss of language skills. Always fatal, Alzheimer's disease is the most common form of irreversible dementia. Approximately 100,000 victims die and 360,000 new cases of Alzheimer's disease are diagnosed each year. It is estimated that by 2050, 14 million Americans will have this disease. America is not alone in dealing with this terrible affliction. In every nation where life expectancy has increased, so has the incidence of Alzheimer's disease. Alzheimer's disease is becoming tragically common. It is estimated that by 2020, 30 million people will be affected by this devastating disorder worldwide and by 2050, the number could increase to 45 million."
American Health Assistance Foundation
22512 Gateway Center Drive, Clarksburg, Maryland 20871
1-800-437-2423, (301) 948-3244, Fax: (301) 258-9454
ghandiboe@ahaf.org
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American Physical Therapy Association, Section on Geriatrics:"Currently comprising over 7200 physical therapists, physical therapist assistants, and students committed to providing quality care for the geriatric client."
http://www.geriatricspt.org/

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Local Chapters:

Alzheimer's Association Central Maryland Chapter:"Services • How to Help • Local Research • Activities • News & Info Table of Contents • About Us • Links • Guestbook • E-mail
1850 York Road, Suite D • Timonium, MD 21093-5142 1-410-561-9099 • 1-800-443-CARE (Outside of Baltimore)
http://www.alzcmd.org/

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Alzheimer's Association, Northern Virginia Chapter...

Alzheimer's Association, Northern Virginia Chapter provides programs services for families caregivers, funds research, and educates the general public, health professionals and governments about Alzhe...
http://www.alz-nca.org

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National Association of Geriatric Nursing Assistants:"The National Association of Geriatric Nursing Assistants was formally established in 1995 by former certified nursing assistants Lori Porter and Lisa Cantrell. Initially working as CNAs, both moved up the nursing home management ladder, Lori eventually becoming a licensed nursing home administrator and Lisa a director of nursing. Throughout their careers, they remained focused on their years as CNAs, realizing that nursing assistants are both the backbone and the heart and soul of the nursing home profession."
National Association of Geriatric Nursing Assistants
2709 West 13th Street Joplin, Missouri 64801
Phone: 417-623-6049 • 800-784-6049 Fax: 417-623-2230
Email: info@nagna.org
http://www.nagna.org/

Categories: Alzheimers Disease, Dementia & Senility, http://www.4nursing.com/alzheimers/
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HealthNewsReview.org | Independent Expert Reviews of News Stories | Holding Health and Medical Journalism Accountable

Like the NPR story we also reviewed, this story about revised guidance on diagnosing Alzheimer’s disease does a nice job of clearly distinguishing what is relevant to readers and what is of interest only to researchers.

Our Review Summary

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This report tells readers the stark reality, that lab tests and brain scans for Alzheimer’s are not ready for clinical use and even when the tests are validated, they will have limited value to patients until effective treatments are developed.

This story includes a comment about how early diagnosis could help patients and families plan for the future; but it would have been nice to see an acknowledgment of the potential psychological and social consequences.

Like the NPR story, this report fails to tell readers about the ties between quoted experts and companies that are developing tests and treatments, even though those ties were disclosed. This story quoted several experts, but none who are independent of the panel that issued the revised diagnosis guidance.

Why This Matters:

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It is more than just validation of the new diagnostic approaches being described that will be needed before these can influence clinical practice. All of the diagnostic test characteristics will need to be examined, including the ability of the test results to accurately predict which patients are likely to develop AD (the false positive, false negative, positive and negative predictive value, etc). Additionally, the reliability of the measures will need to be determined. From a clinical perspective, until there are treatments that can alter progression, other than helping patients understand what to expect in the future, currently there is not a lot of benefit and there are potential harms for knowing early on if a patient has this condition.

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The Alzheimer List, Washington University

As Director of the Alzheimer’s Disease Research Center at Washington University, I reluctantly have decided to phase out the Alzheimer List, effective February 1, 2011.  I have made this decision based on two factors.  First, the use of the list has been steadily declining.  In January 2005, there were 1,057 monthly posts to the List, but in May 2010 there only were 175 posts. This declining use possibly reflects the fact that, since the List was originated in 1994, many more resources now are available for families and caregivers of persons affected by Alzheimer’s disease and other dementing disorders.  Indeed, many of the current posts to the List do not address caregiver or related issues. Second, for us to support the List requires resources such as personnel, hardware, and maintenance of archives.  Although the List is not a major resource burden, in this period of constrained research funding we must manage any expenditures very carefully.  We have notified our funding agency, the National Institute on Aging, of our decision to end the List and they are in agreement.

At end of this message, please find links to other online support groups that may be useful for some of you. The publicly accessible archive of all posts to the List will be maintained after February 1, 2011, (i.e., after the List itself is halted) as the archive has proven valuable for several reasons, including for caregiving research.             

Finally, I would like to thank all of you who have made the List a vital initiative for sharing and supporting caregiver interests.  I also want to recognize Geri Hall for her tremendous contributions to the List over many years; her caring and insightful comments have been of great help to many people and we very gratefully acknowledge her efforts.

Sincerely,

John C. Morris, MD (morrisj@abraxas.wustl.edu)

Alternative Online Support Groups:

Alzheimer’s Association message boards and chat rooms:
http://www.alz.org/apps/we_can_help/support_groups.asp

ElderCare Online Forum:
http://eldercare.infopop.cc/6/ubb.x

Alzheimer's Care Giver Support Group (started by former members of the ADRC Alzheimer List:
http://health.groups.yahoo.com/group/AlzheimerSupport/

---

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Hurting a nurse is a felony, New York State Law Passed

Assaulting a nurse is now a Class D felony under New York state law.

The Violence Against Nurses Law passed this week puts nurses into a protected group that includes police officers, firefighters and emergency responders. A physical attack on a registered nurse or licensed practical nurse (or one of the other service workers in the protected category) is considered a felony and is punishable by up to seven years in prison.

Workplace violence against nurses has been in the news a lot lately. A California psychiatric technician was allegedly killed at the hands of a patient. A doctor assaulted an ICU nurse while he was a patient in Intensive Care. According to the Emergency Nurses Association, between 8 percent and 13 percent of emergency department nurses are victims of physical violence each week.

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Creative Storytelling Intervention Helps Dementia Patients | National Nursing News

Participation in a creative storytelling intervention improves communications skills and demeanor in people with dementia, according to a study by University of Missouri researchers.

The program, TimeSlips, encourages participants to use their imaginations to create short stories as a group. Participation does not require factual recall, but rather responses to humorous images presented by facilitators. The facilitators record the responses and read narratives to further develop or conclude the stories.

“TimeSlips provides rich, engaging opportunities for persons with dementia to interact with others while exercising their individual strengths,” said Lorraine Phillips, RN, PhD, FNP-BC, assistant professor in the Sinclair School of Nursing.

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Online tool can help seniors determine risk for dementia | Johns Hopkins University - The Gazette

A quick online assessment tool developed by Johns Hopkins researchers can help worried seniors find out if they are at risk of developing dementia and determine whether they should seek a comprehensive, face-to-face diagnosis from a physician, according to a new study.

The tool, which is being refined and validated, is not meant to replace a full evaluation from a doctor that includes a physical exam, blood work, imaging studies and more. Instead, this assessment provides a scientific way to help a person educate himself about a disease that doctors now believe is best managed if caught early.

“As the population ages and dementia becomes more prevalent, it’s important to get people diagnosed early,” said Jason Brandt, a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and the leader of the study appearing online in the journal Alzheimer’s & Dementia. “Alzheimer’s disease and other types of dementia don’t just creep up on you. They’re incubating for decades in the brain. This tool is potentially very useful in determining who is at risk.”

Among the questions asked on the Dementia Risk Assessment are whether a person has a history of high blood pressure, depression, diabetes, high cholesterol or head injury, all of which are considered well-documented risk factors for dementia. The assessment also includes a simple memory test that could point to a subtle cognitive decline, Brandt says.

The study analyzed responses from 357 people over the age of 50 who took the assessment at www.alzcast.org. Those who scored lowest on the memory test were significantly older and were more likely to be men, have hypertension and report severe memory problems. And while only 9 percent of respondents reported they had severe memory problems, more than one-third said they had a first-degree relative with dementia or severe memory loss—a major risk factor for the condition.

The assessment takes just five to 10 minutes to complete online, and the questions have been borrowed from other scientifically valid assessments.

via gazette.jhu.edu

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Mass. aims to cut drug overuse for dementia - The Boston Globe

State regulators and the Massachusetts nursing home industry are launching a campaign today to reduce the inappropriate use of antipsychotic medications for residents with dementia — a practice that endangers lives and is more common here than in most other states.

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During the next year, a team of specialists will identify nursing homes with successful methods for avoiding overuse of antipsychotics and determine which homes need help cutting back. Nursing home staff will be taught how to deal with aggressive and difficult behaviors, often displayed by dementia patients, without resorting to antipsychotics to sedate them.

In 2009, 22 percent of Massachusetts nursing home residents who received antipsychotic medications did not have a diagnosis for which the drugs were recommended — the 12th highest rate of inappropriate antipsychotic use in the nation, the Globe re ported earlier this year.

Twice in the past five years, federal regulators have issued nationwide alerts about troubling and sometimes fatal side effects when antipsychotics are taken by people with dementia, often Alzheimer’s patients.

Specialists say that understaffing sometimes prompts overuse of these medications to help control dementia patients’ behavior, but that inappropriate use can also be traced to lack of training in alternative approaches.

“There is a knowledge gap between the front-line workers — the nurses — and the black-box warnings on these medications,’’ said Laurie Herndon, a geriatric nurse practitioner who is leading the initiative for Massachusetts Senior Care, the trade group representing the state’s 430 nursing homes. A black-box warning is the most serious type of caution used in prescription drug labeling.

“We wanted to avoid talking at them, and instead provide educational material they can use,’’ Herndon said.

Campaign details will be unveiled at the association’s annual meeting today in Worcester, which is expected to draw about 900 people.

Alice Bonner, the state’s top nursing home regulator, said she appointed a task force to study the overuse of antipsychotics in nursing homes and develop alternative approaches after the Globe highlighted the problem in Massachusetts earlier this year. The task force includes nursing home physicians, nurses, social workers, and pharmacists, along with elder advocates, researchers, and state surveyors who monitor the quality of the facilities.

Bonner, director of the Bureau of Health Care Safety and Quality in the Department of Public Health, said the state, given its budget problems, does not have new resources to devote to the campaign, but is working with legislators and the Patrick administration to get new funding in the next state budget. The trade association intends to apply for grants from nonprofit groups to fund the initiative.

“No one is going to plunk a whole lot of money in our laps,’’ Herndon said, “but that shouldn’t stop us.’’

Bonner said that the task force has already identified low-cost approaches used by some nursing homes. One approach involves more careful screening of patients when they are admitted, which includes gathering more detailed information from families about the patient’s personality before the onset of illness. This, Bonner said, helps staffers tailor care and activities to each patient.

“They get a good sense of who a person was before they began to suffer with dementia, what kinds of things they like to do, and what kinds of things their family can tell us makes them calm or gets them engaged,’’ Bonner said.

“When you see a nursing home with a low rate of antipsychotics, very often you will see these programs,’’ she said.

Bonner also said that nursing homes that give workers consistent schedules that allow them to work with the same patients have also been successful.

“That helps reduce difficult behaviors with patients with dementia because staff knows the patients so well, they pick up on early signs of trouble and prevent a catastrophic event, so they can intervene early,’’ she said. Consistent schedules have the side benefit of helping nursing homes retain their workers longer, Bonner said. “Once this is in place, it turns out it is less expensive because staff turnover is expensive,’’ she said.

The education campaign will draw on the work of Dr. Susan Wehry, a geriatric psychiatrist and associate professor of psychiatry at the University of Vermont College of Medicine. Wehry recently concluded an intensive, nine-month pilot project in four Vermont nursing homes that taught all staffers, from housekeepers to medical directors, alternative approaches, such as using music and massage, to manage difficult patient behaviors.

The program, she said, helped identify which alternatives work, which don’t, and how challenging the mission can be.

Wehry is still analyzing the results but said preliminary findings showed that in one of the homes where the administrator made all of the training sessions mandatory for staff, antipsychotic use was dramatically reduced. A third of the patients with dementia had been prescribed antipsychotics before the program, and not one was on them by the end, she said.

“They were much improved in terms of staff-resident interactions and level of alertness,’’ Wehry said. “And they looked happier.’’

Data from another home that did not make all of the training mandatory showed no change in the number of dementia patients given the medications. Wehry said a more troubling trend also emerged there — one of the physicians switched from giving antipsychotics to prescribing antianxiety medications.

“If all we do is shift the burden, then all we have done is create a different set of problems,’’ Wehry said. “Our goal is not to just reduce our reliance on antipsychotics, but to change [patient] behaviors.’’

Kay Lazar can be reached at klazar@globe.com

via boston.com

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