For reasons that are understandable yet hard to countenance, antipsychotic drugs are widely used in nursing homes.
Their presence has been driven by this inescapable fact: More than half of all residents have some form of dementia. That means hundreds of thousands of the people being care for experience related behavioral and psychological symptoms. Left unchecked, such challenges can pose significant problems for the staff and residents.
So it’s hardly a surprise that more than a quarter of all residents receive antipsychotic medications, according to data from the Certification and Survey Provider Enhanced Reporting (CASPER) data network from the Centers for Medicare & Medicaid Services. To be fair, these drugs are usually administered for legitimate reasons. For example, they can aid in the treatment of psychotic disorders such as schizophrenia, psychotic symptoms such as delusions and hallucinations, and BPSD in certain situations.
But it also should be noted that they are often administered for reasons that are less honorable, at least from a clinical perspective. Put another way, they are sometimes used to make residents less of a hassle to deal with. And from the looks of things, this latter scenario may be more common than many would like to admit. CMS data show that in 2010 more than 17% of nursing home patients had daily doses exceeding recommended levels.
In response to this unfortunate reality, CMS launched the National Partnership to Improve Dementia Care in 2012. Its laudable goal is to decrease the off-label use of antipsychotics by 15%. Since then, other organizations, including the American Health Care Association, have joined the effort to provide guidance on appropriate antipsychotic prescribing in nursing facilities. Progress is being made, but it has been maddeningly slow.
However, it’s beginning to look like new help may arrive — in the form of the iPod.
Under a new project called the Wisconsin Music and Memory Initiative, iPods with personalized tunes are being distributed to facilities. The idea is to rekindle residents’ memories with familiar music, lift their spirits and improve their interactions with others.
So far the program has been rolled out to 100 facilities, and this number is likely to increase to 135 before summer.
It’s unlikely that this approach will completely eliminate the need for antipsychotics. But it’s certainly worth a try. After all, what would you prefer for a person you care about: zombie pills or an option that’s music to their ears?
John O’Connor is McKnight’s Editorial Director.