DOVER –– A recent effort has been made to reduce and even eliminate the use of antipsychotic drugs on older Americans suffering from dementia.
“Antipsychotics have been around since the 1940s and are used for psychotic conditions like schizophrenia or bipolar disorder but have also been used on patients with various forms of dementia like Alzheimer’s disease,” said Dr. Gerard Gallucci, medical director of Delaware Department of Health and Social Services.
Using medication intended for those with schizophrenia or bipolar disorder on individuals may seem like a strange tactic but it’s not the dementia itself the antipsychotics are targeting, it’s the behavioral problems that accompany dementia.
Even though memory loss is most commonly associated with dementia, other symptoms of the disease include changes in mood or personality, loss of communication, agitation or aggression.
These behavioral symptoms can become challenging for professional and familial caregivers.
“What has been happening over the years is doctors have seen the benefits of the sedative properties of antipsychotics which can make dementia patients calmer and less aggressive but the drugs aren’t helping their medical condition at all,” Mr. Gallucci said. “It’s making them easier to handle and care for and not improving their quality of life at all.”
Although antipsychotics may be an effective method to regulate behavioral symptoms, they have never been approved by the Federal Drug Administration for use on dementia patients. The drugs even carry a FDA-mandated boxed warning stating that they are associated with an increased risk of death when used to treat older adults with dementia-related psychosis.
“Antipsychotics can have all kinds of adverse effects, especially on older individuals with dementia like weight gain, an increased risk of diabetes, cardiovascular disease and falls –– problems this demographic faces without the added risk from prescription drugs,” Dr. Gallucci said. “And it’s a big problem that these drugs are commonly used on dementia patients in longterm care facilities across the country.”
Nationally in 2012 nearly 30 percent of older adults living in longterm care facilities received antipsychotic medications and around 14 percent living outside were on antipsychotics as well, but all that is about to change.
Reducing antipsychotic use
Westminster Village in Dover is leading the charge in eliminating antipsychotic use in dementia patients and since its adoption of an elimination initiative in September 2013, Westminster Village has their numbers down to only 3.3 percent.
“Evidence-based practice was showing that antipsychotic medications had more risk than benefit for most older adults with dementia,” said Westminster’s Executive Director Mary Ann Poling.
And that research has recently been backed up by a national study conducted by the U.S. Governmental Accountability Office. The study, “HHS Has Initiatives to Reduce Use among Older Adults in Nursing Homes, but Should Expand Efforts to Other Settings,” was published on Jan. 30, 2016, and confirmed that antipsychotic drugs should not be used on older individuals with dementia.
The study reported that the risk of using antipsychotics on dementia patients is higher than the benefit and doctors should seek alternative care for their dementia patients.
Westminster uses behavior tracking to determine what works best for individual patients.
“Behavior tracking to identify triggers and an assessment that includes environmental and possible medical causes for the behaviors,” Ms. Poling said.
Examples of behavior tracking include and assessment of pain, when agitation occurs such as during shift change or changes in noise levels, assessment of behaviors in the dining room or large groups.
Patients are also supported in handling personalized tasks and maintaining some independence instead of being discouraged.
“Today if a cognitively impaired resident who is at-risk for falls gets up from her wheelchair, our staff runs to walk with her. Long gone are the days when we restrain residents or even gently push them back in their chair. Really knowing the residents and keying into their individualized needs, residents live a higher quality of life,” Ms. Poling said.
Dr. Gallucci said in some cases, there are prescriptions that can help dementia patients at the onset of the disease that can slow down the progression but not stop it completely.
Antidepressants can reduce not only depression but anxiety which many patients experience, which can improve behavioral symptoms at all.
So with alternative therapies and other pharmaceutical options, there are many methods other than antipsychotics to help those struggling with the effects of dementia.
The perfect combination of effective personalized treatment measures relies on the cooperation of many parties like doctors, medical providers, caregivers and families.
“Westminster has been a great example of this,” Mr. Gallucci said. “I actually visited a few weeks ago and was very impressed by the enthusiasm of the staff and how effective their use of alternative therapies have been.”
Ms. Poling said that residents who have been removed from antipsychotics have been less lethargic, more engaged in daily activities, more communicative and have experienced a better quality of life.
Sen. Thomas Carper, like Dr. Gallucci, made a recent trip to Westminster Village to see their changes in action.
“Our seniors deserve the highest quality of healthcare and social services, and I’m so proud that Delaware and Westminster Village are leading the way in that important effort,” he said. “Caring for the elderly with dementia and cognitive deficiencies is a difficult job — but also a sacred one, and we’ve got to make sure we’re getting it right.”
High cost of dementia
When it comes to looking at the full picture of dementia patients on antipsychotics, the unnecessary use and over prescription of the medication is taking a toll not only on its patients but Medicare too. The Governmental Accountability Office reported that about 15 percent of older Americans have dementia, racking up between $157 billion and $215 billion in medical costs annually. Of that, Medicare pays around $11 billion.
Of the $11 billion, $363 million was spent specifically on antipsychotic prescriptions for elderly adults with dementia in 2012.
Current estimations show that Medicare’s payment into dementia treatment will more than double by 2040 due to the aging of the American population making the reduction of antipsychotic use in dementia patients not only necessary for patients’ quality of life but the economy as well.
“This Government Accountability Office report details the troubling reality that many of our nation’s seniors diagnosed with dementia are receiving risky mind-altering medications at too high a cost for their health and taxpayers,” said Sen. Carper. “The rates of improper prescriptions to these vulnerable older adults, and the cost to taxpayers of those prescriptions through Medicare Part D, are deeply concerning.”
For more information concerning the medical and financial costs of prescribing antipsychotics to dementia patients, visit gao.gov.