Transforming America’s Alzheimer’s Care Culture
More than 5 million Americans have Alzheimer’s and related dementias. As the quest for a cure continues, people living with Alzheimer’s and related dementias deserve the very best care and life quality now. Unfortunately, America’s care culture too often defaults to long-term sedation of people who have behavioral symptoms of Alzheimer’s and related dementias. Such behavioral symptoms can include but are not limited to screaming, physical outbursts, extreme sleeplessness, and severe agitation.
Why Does This Care Culture Occur?
Often a nursing home, assisted living community, or at-home caregiver will call a physician to get medication to sedate a person’s behavioral symptoms, or a person will be discharged from a hospital in a sedated state for safe transfer to a new setting. Many of these people do not have a diagnosis of psychosis. The fastest way to “quiet” behaviors is through an antipsychotic. Quiet occurs, but it too often stays.
We know behavioral expressions are expressions of unmet needs. If we don’t identify environmental factors or triggers fueling a person’s behavioral expressions and we don’t take time to address them, we lose the opportunity to “hear” what the person is conveying and truly care for them. Unfortunately, the default-to-drugs approach is too often embraced as the easier “care” approach.
Reducing Risks and Costs
Antipsychotics play a very helpful role in many people’s wellbeing, but they can be misused in care of people with Alzheimer’s and related dementias. According to a national audit of the federal Medicare program by the Office of the Inspector General released in 2011, more than half of the antipsychotics paid for by the federal Medicare program in 2007 were “erroneous,” costing the program $116 million in just six months. Federal rules require that any drugs that are paid for by the government be given only for uses approved by the government or one of three independent drug usage encyclopedias.
Antipsychotics put older adults at high risk for decreased cognitive function, stroke, pneumonia (60% higher risk) and other adverse drug events. In fact, seniors taking antipsychotics are as much as four times more likely to experience an adverse drug event that can lead to hospitalization or death. With the prevalence of Alzheimer’s and related dementias, antipsychotics are most states’ largest Medicare and Medicaid drug expense, at a cost of more than $4 billion nationally.
Awakenings combines skills and expertise of physicians, care professionals and pharmacists to healthfully avoid inappropriate use of antipsychotics and create an enriching living environment that often helps people with Alzheimer’s and dementia from ever moving to antipsychotics.