Health In Focus
  • Dementia can cause agitation in the elderly
  • Antipsychotics are often prescribed to control the agitation, but can increase the risk of stroke and death
  • Researchers advise limiting the use of antipsychotics in these patients

Researchers evaluated a training program launched by the Massachusetts Senior Care Association and the Massachusetts Department of Health program called "OASIS." The program trained nursing home staff to avoid the use of antipsychotic drugs in patients with dementia. The study was published in the JAMA Internal Medicine.

Dementia is a condition where the brain function tends to reduce with age. The ability to do things that were learned during the lifetime decline during the golden years. This period is not only distressing for the patient but can be extremely frustrating for the caregivers. Quite often, the agitation and aggressive behavior of the patients is treated with antipsychotic drugs, though they may not be officially approved for the purpose. Antipsychotic drugs include drugs like Olanzapine, Risperidone and Aripiprazole that are used to control psychotic symptoms like mania and hallucinations in patients with bipolar disorder.
Antipsychotic Drug Usage is Best Avoided in Dementia Patients

The use of antipsychotic drugs to treat agitation in dementia patients who cannot communicate their needs may not the right approach. Researchers have suggested that the agitation in dementia patients may be an expression of their needs that have not been addressed and should be approached in the same way as one would approach a child. They introduced a program called "OASIS" to train nursing staff to address the needs of dementia patients with a more human approach. The program empowered the staff to understand and fulfill the patients' requirements, rather than just drugging them with antipsychotics. The staff was also encouraged to integrate the strengths of the residents in the daily care plans.

To test the effectiveness of their program, the researchers compared the use of off-label antipsychotics in 93 nursing homes that were enrolled in the "OASIS" program as compared to 831 homes that were not enrolled in the program.

The researchers found that:
  • The use of off-label antipsychotics reduced by 7.6% in those homes that were enrolled in the "OASIS" program over a period of nine months, while it reduced by 3.9% in those homes that did not follow the program. The program thus appears to have a positive impact in the approach towards dementia patients.
  • The main decrease in antipsychotic use was noted during the six-month implementation period of the program, but was not sustained during the three-month maintenance period following this phase.
  • The patients did not need additional psychotropic drugs or did not experience more behavioral changes despite the reduced use of antipsychotic drugs.
Antipsychotic drugs are associated with an increased incidence of stroke and death in the elderly. Therefore, minimal use of these medications would definitely benefit this population.

Reference :
  1. Tjia J et al. Association of a Communication Training Program with Use of Antipsychotics in Nursing Homes. JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2017.0746
Source: Medindia

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