Drugs and Dementia Care: Unnecessary, Ineffective and Costly

I've learned the sad truth that a hard drive can be like an attic or a basement: It too can get very cluttered. I've spent several evenings thinning out and organizing files in "My Documents." This evening I came across the article below. I believe I wrote it with the intention of posting it. However, I do not see it listed in my 6 years of blog posting, so here it is! It was written in 2010 prior to the publication of Dr. Al Power's marvelous book, DEMENTIA BEYOND DRUGS.
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Isn’t it amazing how often compassion and common sense aren’t validated until there is an official study or series of studies that address the issue involved.

Within the past year or so there has been one news report after another indicating the prevalence of nursing home residents with dementia being prescribed anti-psychotics. This exists in the face of Black Box Warnings by the FDA indicating that elderly residents with dementia are at an increased risk of death when certain anti-psychotics (Seroquel is a big one) are part of the drug regimen.

Recent Research
A study in Australia was reported in the September issue of Caring for the Ages. The residents in that study all had progressive dementia “with persistent behaviors that made it difficult for staff to care for them.” One group of caregivers was provided two-day training in person-centered care with dementia residents. The residents were tested with scientifically valid check lists to indicate their level of agitation at the beginning of the study and then at four and at eight months after the beginning of the study.

Results
After four months, those residents with dementia receiving “usual care” showed an increase of agitation of almost 9 points on the scales that were used. By contrast, those residents who were cared for in the person-centered care model, showed a decrease of 9 points on the same agitation scale.

So there’s the scientific proof --- medical professionals refer to it as “evidence-based” approach to care –

Drugs prescribed for patients with dementia are not always unnecessary. But it is clear that reaching for a prescription pad the moment a behavior is observed is not good medicine even though it is a prevalent practice in too many nursing homes. Dr. Al Power is a geriatrician and certified medical director who practiced at St. John’s Home in Rochester, NY. He has a book that will be published in the early part of 2010 on this very topic of non-pharmacological approach to dementia care. In his own nursing home practice, Dr. Power told me, an average of six percent of his dementia patients at St. John’s were on anti-psychotics. That’s a wonderful contrast to the national average among nursing home residents with dementia of twenty-eight percent

The call to liberate our elders
When this evidence-based, person-centered approach is used, these elderly residents have been set free from the shackles of unnecessary drugs. Let the work go on!

My Mother . . . . Mama

Recently I received an e-mail from an acquaintance, Lucille I’ll call her, after a long gap in our communications. It was a one-line message: “My mother will probably die today or tomorrow. Please pray.” I responded immediately, sending my prayers and my support. My message included the following: “Regardless of the path there has been in any mother-daughter relationship, I feel it is always the little girl in us who loses her mother.”

Later that same morning I received another e-mail from this woman: “Mama just died at 11:15.”

Consciously or unconsciously, I felt that Lucille had affirmed my feelings about a daughter’s loss of her mother. No longer ‘my mother’, but ‘Mama” what we as children called our mother.

Among the many emotions surrounding my grief at my own mother’s death was one of loss, and the knowledge of the unremitting absence of death that the “little girl” in me felt so keenly. My mother died while she was a resident in a nursing home in the Dallas metroplex. At the time I was living and working as a community organizer in South Carolina and received a shocking phone call one evening from my brother with the news that my mother had died. I had spent an extended period of time with my mother just six weeks prior, as I did regularly and periodically.

My first morning back in Dallas I went to the nursing home as soon as possible. I wanted to learn as much as I could about my mother’s last day. As I walked from the entrance down the hallway, the administrator, Mrs. Wesley, saw me; she left her office, met me, put her arm around my waist and walked me back to her office. I don’t remember a single word of our conversation in her office. I only remember her warmth, compassion and empathy.

For those of us who work in aging services, we walk this path with so many families as they lose a parent. It is part of the day-to-day tasks in our line of work. May we never allow these events to fall into the category of the ordinary lest we not be ready to share our warmth, compassion and empathy with an adult child who just lost his/her Mama.