This Nursing Home Calms Troubling Behavior Without Risky Drugs : Shots - Health News The staff's goal was to reduce the prescription of antipsychotic drugs by 20 percent. In the first year, they cut use by 97 percent. How? By addressing the real reasons for agitation and aggression.
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This Nursing Home Calms Troubling Behavior Without Risky Drugs

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This Nursing Home Calms Troubling Behavior Without Risky Drugs

This Nursing Home Calms Troubling Behavior Without Risky Drugs

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ROBERT SIEGEL, HOST:

One in five people in nursing homes are given powerful antipsychotic drugs. That's even though those drugs are approved mainly for serious mental illnesses such as schizophrenia and bipolar disorder. And this happens despite warnings from the FDA that the drugs can increase the risk of death for people with dementia and Alzheimer's disease. Nationwide, almost 300,000 nursing home residents are given antipsychotics.

AUDIE CORNISH, HOST:

NPR's Ina Jaffe covers aging. This morning she reported the federal government has pushed nursing facilities to reduce their use of these drugs by 15 percent. Now she takes us to Minnesota, where a few years ago, a group of nursing homes figured out how to cut their use of antipsychotics by more than 90 percent.

JESSICA ABBOT: Elaine do you want to come out and bake some apple crisps with me? We're going to get a group of people together.

INA JAFFE, BYLINE: About half a dozen older women join staffer Jessica Abbot at a long counter in the dining room at Pathstone Living. It's a memory care center and nursing home in Mankato, Minnesota.

ABBOT: There's no hurry. I'll see you in a little bit. Dorothy?

JAFFE: Seems there's always something to do around here. It helps relieve the agitation common in some people with Alzheimer's or other dementias - agitation that, in other nursing homes, might be managed with antipsychotic drugs. In fact, around the country, nearly 20 percent of nursing home residents get those drugs even though the FDA says they can be deadly for people with dementia. A few years back, Pathstone also used antipsychotics frequently.

SHELLY MATTHES: We saw these as medications that were supposed to help the patient. And, of course, we gave them to them with the feeling that we were doing good.

JAFFE: That's nurse Shelly Matthes. She's the director of quality assurance for the nonprofit that owns Pathstone and about a dozen other nursing facilities in Minnesota. It's called Ecumen. Psychiatrist Tracy Tomac, a medical consultant at Ecumen, says a resident might have been started on antipsychotics to deal with an emergency.

TRACY TOMAC: But then they would just stay on it. It would never be taken off for many months or even years.

JAFFE: So in 2009, Tomac and a colleague at a small Ecumen nursing home near Duluth decided to see if they could reduce the use of antipsychotics there.

TOMAC: At the end of six months or so, we were able to get them all off of any antipsychotics successfully.

JAFFE: So the next year, they extended the policy to all of Ecumen's nursing homes, says Shelley Matthes.

MATTHES: Our goal then was to reduce our antipsychotic use by 20 percent. And in the first year, we reduced it by 97 percent.

JAFFE: At Pathstone these days, around 5 to 7 percent of residents get antipsychotic drugs. Not all of the Ecumen nursing homes have numbers that low, but they're almost all well below the national average. And Matthes says the changes in the residents were as dramatic as the drop in the numbers.

MATTHES: They started interacting, and people who hadn't been speaking were speaking. They came alive and awakened.

JAFFE: Which is why they decided to call their program Awakenings.

MAC: Yeah. I know what it is, where it is, why it is.

JAFFE: A resident called Mac talks to staff members and sometimes himself as he meanders around the skilled nursing wing at Pathstone.

MAC: And we got a perfectly good house sitting down at the bottom of the hill.

JAFFE: When he arrived at Pathstone, Mac was on antipsychotic drugs. He also had a tendency to fall, which meant he wasn't allowed to get around on his own, and that upset him. So first, the staff weaned him off antipsychotics. But they also needed to deal with what was making him unhappy. The answer was a device that's - well, it's hard to describe. It's sort of a walker on wheels but with railings and a chair. Anyway, the important part is that Mac's got some independence back with a little encouragement from nurses like Joel Berglund.

JOEL BERGLUND: Do you want to walk, Mac? Can you take a step?

MAC: OK.

BERGLUND: There we go.

JAFFE: Nurses aren't the only ones here expected to help. Maria Reyes, who's in charge of the Awakenings program for all of Ecumen's nursing homes, says everyone on the staff is trained to know and understand the residents' likes, dislikes and life stories.

MARIA REYES: We want everyone to know, whether they are working in the dining services or maintenance, that when you see something that is, quote, quote, "a behavior," try to figure out the rationale behind it. And once we figure that out, we can oftentimes eliminate it completely.

JAFFE: Ecumen doesn't take credit for inventing the techniques they use. There are a lot of approaches to individualized care for people with dementia. And Reyes says the Awakenings program has borrowed something from just about all of them.

REYES: Aromatherapy, white noise, pet therapy, validation - all the different principles that we infuse in our care.

SHELLY CORNISH: Tina, you're just going to watch, right? That's fine.

JAFFE: Back in the dining room, apple crisp is still a work in progress. Meanwhile, Shelly Cornish, director of the memory care unit, points out a vintage chest of drawers in the far corner.

S. CORNISH: Every drawer that you open, you're going to find a treasure.

JAFFE: Treasures like an old-fashioned hat, for instance, or a book of recipes that hails from the days when meatloaf was king.

S. CORNISH: And, really, the meaning behind that is that sometimes people who have dementia are looking for something, but they don't necessarily know what it is they're looking for.

JAFFE: In some nursing homes, that constant searching would be a problem-behavior to be managed with risky antipsychotic drugs. Here, it's just another need that can be satisfied with a trifle from days gone by. Ina Jaffe, NPR News.

SIEGEL: If you want to know how nursing homes in your area rate when it comes to using antipsychotic drugs, go to npr.org. You can search for information on antipsychotic drug use at more than 15,000 facilities around the country.

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