DRUGS: 100 care facilities saw a significant drop in antipsychotics for dementia when staff were trained to focus on “treating the residents as human beings with needs, not as patients with problems.” Find out more about this study, one of the largest of its kind, ever.
The use of antipsychotic medication in nearly 100 Massachusetts nursing homes was significantly reduced when staff was trained to recognize challenging behaviors of cognitively impaired residents as communication of their unmet needs, according to a study led by Jennifer Tjia, MD, MSCE, associate professor of quantitative health sciences. Results of the study were published in JAMA Internal Medicine.
Reduce Use
“This is the largest study to show that it is possible to reduce antipsychotic use in the nursing home population,” said Dr. Tjia. “This intervention focused on treating the residents as human beings with needs, not as patients with problems. We don’t medicate babies when they cry or act out, because we assume that they have a need that we need to address. However, when people with dementia are unable to communicate, the current approach medicates them when they have undesirable behaviors.”
The off-label prescription of antipsychotics for nursing home residents with dementia is common, despite numerous studies that have shown it increases risk of stroke and death and is only minimally effective in controlling behavioral symptoms of dementia.
Meet the Needs of Residents
Tjia studied the influence of a communication training program called “Oasis” for nursing home staff on off-label antipsychotic use. The Oasis curriculum and training—launched by the Massachusetts Senior Care Association in collaboration with the Massachusetts Department of Health and developed by geriatric psychiatrist Susan Wehry, MD,—equips frontline nursing home staff, such as nursing assistants, nurses, dietary staff and receptionists, with the knowledge, skills and attitudes to meet the needs of residents with dementia using nonpharmacologic approaches rather than medication. Ironically, the program reached very few prescribers, but was still able to significantly reduce antipsychotic use.
“The Oasis program asks nursing staff to create care plans that include what residents can do, shifting away from the model that focuses on what they can’t do,” Tjia said. “This is a fundamental shift in how to think about caring for persons with dementia and we showed that it is effective.”
Significant Drop
This study examined the rate of off-label antipsychotic use in 93 Massachusetts nursing homes enrolled in the Oasis intervention from 2011 to 2013, compared to 831 nursing homes in Massachusetts and New York who were not using that program, (although some were using a different reduction program.) Among Oasis facilities, the prevalence of antipsychotic prescriptions was cut from 34 to 27 percent after nine months, a 7 point drop, making for a relative 20% decrease. At the comparative facilities, the prevalence of those drugs was cut from 23 to 19 percent; a 4 point drop. No increases in other psychotropic medicine or behavioral disturbances were observed. Over the maintenance period of the intervention, however, the decreases did not continue.
“Since 1987, no fewer than 11 controlled studies have been published that report varying efficacy in reducing antipsychotics in nursing homes using a variety of approaches. The largest successful intervention enrolled 12 nursing homes; however it was time and resource intensive. In contrast, the Oasis program reached almost 100 nursing homes, and was effective,” Tjia said.
Tjia said nursing homes using the Oasis program need to reinforce training periodically to maintain success at reducing the rate of antipsychotics.
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Association of a Communication Training Program With Use of Antipsychotics in Nursing Homes
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Jennifer Tjia, MD, MSCE1; Jacob N. Hunnicutt, MPH1; Laurie Herndon, MSN2; et al
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Teepa Snow has been an advocate for this approach for years. Some of the videos she markets are useful for caregivers. She calls this approach Positive Approach to Care. Naomi Feil and her daughter Vicki de Klerk-Rubin are on their third edition of a book that emphasizes the same techniques, called Validation. The daughter has a book out in her name that is in the third printing. I have first hand caregiver experience with challenging behaviors, and welcome more entry's in this field, so "OASIS" is an approach I will learn about and use.
Teepa has an amazing approach ❤️
My mother was taken off all anti-depressant, and antipsychotic medication, without me knowing beforehand. When I found out, they said, "Oh yes, your mother is doing fine without them." I couldn't help but notice she was eating on her own, and was more alert and able to scoot around in her wheelchair. When I asked why they took her off the medications, they said, "Medicaid is cutting back and not covering the cost of these drugs for the residents." I think the reason for taking them off the meds wasn't good, but it ended up being better for mom. I wonder if the facilities mentioned in this study were taken off due to cut backs and not just for experimental reasons. Can you tell me the answer to that question. Thanks.
As an after thought…what happened to the other 80% who were taken off. Were they put back on the medication? I can't help but be amused and disgusted that people caring for people need to be reminded that they are humans! Seriously. That is the case, but when they don't have pills to medicate and sedatad the patients, they are forced to manage their needs and I hope the staff are monitored during this change, so they keep treating them like humans, and not animals. Check out my website for helping caregivers. Redefining Caregiving @ http://www.samdamm.com
Please you where so positive then it came please answer me this?
You all you family members are able to complain about the care and know how difficult it is why don’t you keep them with you instead you send them to nursing homes and hope they can handle the behaviour we also are human and are learning how to cope with all the different behaviours. If nursing was one on one this would be amazing to spend all day just focusing on that one person but that would cost to much so here we are trying to do the best with what we have.