By Shelley Matthes RN-BC, BSN, RAC-CT, Director of Quality Improvement, Ecumen
Antipsychotic drugs were first developed in the 1950s and they proved to be beneficial for individuals with a diagnosis of psychosis.
However, over time, these medications have increasingly been used on a long-term basis to help manage individuals with non-psychotic disorders, including people who have Alzheimer’s disease and related dementias.
Initially antipsychotics were thought to help those with dementia. The general belief was that these medications could provide a quick fix by managing behaviors and alleviating misery through sedation.
Consequently, when a person with dementia exhibited advanced behavioral symptoms such as physical and verbal outbursts, severe sleeplessness, acute agitation and aggression, the first course of action was often an antipsychotic.
This became the accepted and often standard course of action.
However, we now understand a great deal more about Alzheimer’s and related dementias. We’ve learned behavioral expressions are a person’s way of communicating unmet physical or emotional needs. These highly powerful drugs do nothing to stop feelings or relieve distress, they only mute the symptoms.
While the drugs sedate the person, they can also create a zombie-like effect, taking away the ability to smile, talk or interact in any meaningful way, especially when used long-term when there is not a diagnosis of psychosis.
And, for those with dementia – mainly an elderly population – long-term use of antipsychotics also can add complicated medical issues. As people grow older, their bodies physiologically change, affecting how medications are absorbed, metabolized and eliminated.
Drug build-up in the body, can further decrease cognitive function and cause deliriums, stroke, pneumonia and diabetes. Additionally, adverse drug events due to these medications may also lead to increased hospitalizations and even death.
Awakenings is at the forefront of a movement to change the way we view medicating people with Alzheimer’s disease.
Our goal is to move away from using these intense drugs as an automatic first-step choice in memory care, and instead strike a balance between non-pharmacological and biomedical approaches.
Awakenings care is not anti-drug. We are pro-ability. Our research has shown us that utilizing medications appropriately – at the lowest effective dose -- and then scrutinizing their continued use and integrating a variety of other integrative approaches often leads to healthier, happier individuals.
Over a three-year period, Ecumen staff collaborated to decrease the use of psychotropic medications in its 15 nursing homes.
Utilizing an individualized, person-centered approach we were able to dramatically reduce the use of antipsychotics across Ecumen’s nursing homes to a 13 percent average, with many in the single digits.
The national average of antipsychotic use in nursing homes is 25.4 percent.
Eliminating unnecessary drug prescriptions can also result in a huge savings for families and government programs. In fact, the prevalence of antipsychotic prescriptions account for most states’ largest Medicare and Medicaid drug expense, amounting to a staggering $4 billion annually.
Equally important is the fact that eliminating or reducing many of these powerful medications resulted in a vastly improved quality of life for the individuals under our care.
It’s time to embrace a new way of looking at how we medicate those with Alzheimer’s and other dementias. Awakenings is showing us care professionals can make tremendous change in this area and make lives better.