CMS Sets Goal of Reducing Inappropriate Prescribing of Antipsychotics
In May 2012, the Centers for Medicare & Medicaid Services (CMS) launched a major initiative to curtail the inappropriate prescribing of antipsychotics for nursing home residents with dementia. An estimated 40% of nursing home residents with dementia receive these medications. The new National Initiative to Improve Behavioral Health and Reduce the Use of Antipsychotic Medications in Nursing Home Residents has set a national goal to reduce off-label antipsychotic use by 15% by December 31, 2012. This is an important goal.
As those of us working in long-term care (LTC) know well, behavioral symptoms of dementia vary and can be quite disturbing for residents. Common symptoms include agitation, aggression, resistance to care, wandering, hallucinations, and sleep disturbances. Although the prescribing of antipsychotics for these symptoms is common, these drugs are typically less effective than alternatives.1 In addition, the drawbacks of these medications are significant. They have been found to increase the risk of confusion, blurred vision, difficulty urinating, stroke, and death in older adults.2 In light of this, the 2012 American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults advises clinicians to avoid prescribing these drugs for behavioral problems in older adults with dementia—both those in LTC and those living in the community—unless nonpharmacological options have not worked and if the patient is a threat to himself or herself or to others.1 Barring that, the American Geriatrics Society (AGS) and other organizations recommend an approach that calls for screening, identifying, and addressing underlying contributors to behavioral symptoms of dementia with a comprehensive treatment plan.1,2
To promote this approach for LTC residents who have dementia and related behavioral problems, CMS is, among other things, encouraging nursing homes to take advantage of its “Hand in Hand” training program. (More information can be found at www.cms-handinhandtoolkit.info.) The program teaches nursing home staff how to employ nonpharmacological alternatives in caring for this population. If you haven’t already taken advantage of the program, we suggest you consider doing so. We also suggest you look at the wealth of easily understood information about dementia written for laypeople (eg, relatives of LTC residents who have behavioral symptoms of dementia) on the AGS’ Foundation for Health in Aging Website, www.healthinaging.org, and share it with others.3 The Health in Aging Website also offers comprehensive tip sheets and videos for patients and caregivers to review, as well as research summaries on the latest developments concerning medication management, dementia, and other related health topics. The more we all know about dealing with dementia, including its symptoms and its treatment, the better.
References
1. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J
Am Geriatr Soc. 2012;60(4):616-613.
2. Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic management of behavioral symptoms in dementia. JAMA. 2012;308(19):2020-2029.
3. AGS Foundation for Health in Aging. Dementia lifestyle and management. www.healthinaging.org/aging-and-health-a-to-z/topic:dementia/info:lifestyle-and-management. Updated March 2012. Accessed January 8, 2013.
