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Sedative use drops at nursing homes

Original source:

Boston Globe
Kay Lazar
JULY 12, 2013

A pilot program to reduce the use of antipsychotic drugs in 11 Massachusetts nursing homes lowered rates by 21 percent in the first year, according to data provided to the Globe by the state’s nursing home trade association.

The initiative, organizers said, was prompted by a 2010 Globe analysis that found use of the powerful sedatives in Massachusetts nursing homes was the 12th highest in the country, with thousands of frail elders, many suffering from dementia, receiving the medications unnecessarily.

Encouraged by the results, the industry group expanded the campaign to 104 other homes last year, but preliminary results from the first few months show reductions in those facilities were less dramatic, 7 percent. That was little different from the 6 percent drop seen in homes not participating in the program.

Organizers say they will have a better sense of whether the larger program is working after a full year of data is in later this year.

“When we got the results back from the pilot, we were absolutely delighted,” said Laurie Herndon, director of clinical quality for the Massachusetts Senior Care Foundation, which launched the program. “We have reason to hope that improvements can be sustained.”

The use of antipsychotics in nursing homes is especially troubling because roughly half of the residents in Massachusetts’ 427 nursing homes have Alzheimer’s disease or a similar cognitive impairment, a condition that puts them at greater risk of death when given antipsychotic medications. Federal regulators have issued nationwide alerts about serious and sometimes fatal side effects when antipsychotics are taken by people with dementia.

Using a $182,000 state and federal grant, Mass. Senior Care in September 2012 expanded its OASIS program, which trains nursing home staff to use alternatives to sedation for residents who are agitated and aggressive and who wander — challenging behaviors often found in people with dementia.

OASIS teaches staffers that aggressive behavior by a resident who is no longer able to speak may be that person’s way of communicating pain, and to search for the source of the pain, for instance an untreated urinary tract infection.

The program also teaches staffers to comb residents’ pasts to learn their preferences, hobbies, and accomplishments, tapping bedrock emotions that endure long after memory fades. That helps workers tailor activities and surroundings for each resident, to make the place familiar and comforting.

Donna Nowak-Scibelli, a social worker at Birch Manor Rehabilitation and Skilled Nursing Center in Chicopee, said that in her 29 years of experience, this is “the first time [regulators and administrators] have said, here is a problem and here is a program to help you solve that problem.”

Use of antipsychotics in residents not diagnosed with a condition that would warrant use of these drugs dropped from 28 percent in 2011 to 27 percent last fall in the first few months of the OASIS program at Birch Manor, according to Mass. Senior Care’s data. Since then, it has dropped to about 22 percent today, Nowak-Scibelli said.

“This program has helped all of us to be more cognizant of the risk versus benefits of all we do, but specifically with these medications,” she said.

Among the patients taken off antipsychotics was a woman in her 80s with Alzheimer’s who came to Birch Manor last year from a facility that handled people kicked out of other places because of bad behavior. She didn’t make eye contact and could barely propel herself in her wheelchair.

“We said, let’s see what happens when we take her off these medications,” Nowak-Scibelli said. “The woman is now playing balloon volleyball. With this lady, it was a remarkable improvement.”

At Heritage Skilled Nursing and Rehabilitation in Lowell, the inappropriate use of antipsychotics dropped from 37 percent of residents in 2011 to about 26 percent last year.

One notable case was a man in his 70s with mental illness, a stroke, and early dementia who used a wheelchair but was still strong and quite violent, once choking his sister. Heritage staffers were able to reduce his antipsychotics by teaching him coping skills, such as deep breathing to control his anger, said Donna Howie, director of the home’s geriatric psychology program.

The man’s behavior and condition improved so much, she said, he was able to move to assisted living, where he was reunited with his beloved cat.

“It’s better to give life than a pill,” Howie said.

Mass. Senior Care’s Herndon said the foundation aims to secure more grants to expand the program to additional nursing homes.