Training Nursing Home Staff in Understanding Needs Can Reduce Antipsychotic Use

By training staff to better understand residents’ symptoms and behaviors antipsychotic use dropped 7%

Marta Pagán-Ortiz
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The prescription of antipsychotics for residents of nursing homes is common, despite the many risks found in research. A new study published in JAMA Internal Medicine, the largest study of its kind, has shown it is possible to reduce the use of antipsychotics in nursing homes, by engaging their staff in a training program designed to target residents’ strengths and their unmet needs. The Massachusetts Senior Care Association, in collaboration with the Massachusetts Department of Public Health, used the training curriculum, dubbed OASIS, in an initiative to safely reduce the off-label use of antipsychotics in treating symptoms of dementia.

In a press release to UMassMedNow lead author Jennifer Tjia stated,

“This intervention focused on treating the residents as human beings with needs, not as patients with problems. We don’t medicate babies when they cry or act out, because we assume that they have a need that we need to address. However, when people with dementia are unable to communicate, the current approach medicates them when they have undesirable behaviors.”

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Antipsychotics are frequently used in nursing homes to treat behavioral and psychological symptoms of Alzheimer’s disease and dementia. The use of these, however, has been linked to higher risks amongst elderly populations, including an increased risk of stroke, mortality rate, and other adverse events. Despite recommendations and other efforts to decrease the use of these in nursing homes, the rates of antipsychotic prescription for the elderly had not reduced.

For this study, the authors aimed to understand the large-scale impact of the training program, OASIS, on antipsychotic use in nursing homes. They wanted to understand that if by training nursing home staff, both direct and indirect, to reframe their understanding of residents’ behaviors as unmet needs, this could influence their prescribing practices.

An innovation of the intervention was its focus on staff and not prescribers. OASIS curriculum was designed and authored by Dr. Susan Wehry, a geriatric psychiatrist. The curriculum module targets a number of issues, including understanding residents’ strengths as part of the care plan, providing a holistic and integrated view of dementia, understanding behaviors as communication, and prevention rather than response. Its indicators of success are listed as the following:

  • Reduction in inappropriate use of antipsychotics
  • Higher rates of consumer satisfaction when surveyed
  • Higher rates of staff satisfaction when surveyed
  • Fewer resident incidents
  • Reduced staff turnover
  • Increased number of observable institutional practices reflective of culture change in care, workplace, and environment

The researchers analyzed data from 93 nursing homes enrolled in the OASIS intervention and found significant reductions in antipsychotic use at the OASIS facilities in comparison to the non-OASIS facilities (n=831). The OASIS facilities saw a 7% drop, compared to the 4% drop at the non-OASIS facilities.

The implementation of OASIS did not lead to increases in other observable psychotropic medications or behavioral disturbances. The decreases in antipsychotic use, however, were not sustained during the maintenance phase of the program, which the authors discuss might point to a need of reinforcing the training periodically to sustain the influence of the program.

 

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Tjia, J., Hunnicutt, J. N., Herndon, L., Blanks, C. R., Lapane, K. L., & Wehry, S. (2017). Association of a communication training program with use of antipsychotics in nursing homes. JAMA Internal Medicine. (Abstract)

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Marta Pagán-Ortiz
MIA-UMB News Team: Marta E. Pagán-Ortiz is a doctoral student and research assistant in the Counseling and School Psychology PhD program at UMass Boston. Marta is currently working on research studies related to mental health treatment guidelines for chronic illnesses, issues of structural violence within minority populations, and the reduction of disparities in mental health status and care.

10 COMMENTS

  1. Psychiatric living will http://www.google.com/search?q=Psychiatric+living+will A psychiatric advance directive is also a good search term. Staff in these places usually don’t know what akathisia is. I worked in nursing home years ago and I didn’t know what it was but now I know what I saw was drug induced akathisia not just bad nerves from being old. I was not a nurse but I don’t think they knew either.

    Akathisia remains one of the most prevalent and distressful antipsychotic-induced adverse events. http://www.google.com/search?q=akathisia

  2. By the very fact that these toxic drugs are used to control behavior in people with dementia just goes to show that they are nothing more than major tranquilizers and nothing more. They certainly do not treat any “disease” known as “mental illness”.

    It’s not bad enough that a person is old and can’t make heads or tails of what is going on around them, confused and distressed. Now we drug them with neuroleptics so that their brains will be even more messed up than they already are. Using these drugs on the older population just goes to show that the drug companies are throwing their nets wider and wider to capture more people in an attempt to make more money.

    There are former drug reps who’ve turned whistle blowers who talk about how they were instructed by their supervisors to go into nursing homes and push the medical directors and staff to use these drugs on people who have great difficulty getting anyone to listen to them and take up for them. I listened to one interview with a former woman rep describe how she went into nursing homes and pushed these drugs. She said that in one place there was a very striking older woman who dressed well, did her own make-up, and who was very much with it. But she was opinionated and spoke out when the staff did not do their jobs. The drug rep said that the next time she saw this woman she was locked in a geri-chair and was drooling on herself because the staff took her advice and zapped this woman who once spoke out for her own needs.

    I once worked in a very good nursing home and saw the very same thing happen there to people who were outspoken and who complained that staff didn’t do their jobs. If they spoke out too much they ended up being drugged to the gills so that they could do nothing more than sit in the corner and drool on themselves.

    This is criminal and people should be in prison for all this but instead they’re pulling in salaries in the millions of dollars and are making bonuses hand over fist. There is no justice in this world.

  3. “Training nursing home staff in understanding needs can reduce antipsychotic use”, especially when that training is in not using “antipsychotics”.

    People don’t realize how debilitating neuroleptics are, and part of the reason is that while cautioning people not to use the drugs on nursing home patients, it is considered alright to give them “on label” to people labeled “schizophrenic” or “bipolar”.

    Do something about this “off label” prescribing, and we are well on our way to reducing “on label” prescribing.

    Yes, if it’s not okay to kill the elderly, maybe it’s not such a good idea to kill other people who seem lost and confused either. Due to the use of these drugs, people in treatment for serious mental conditions so-called, are dying earlier than the rest of the population. Just like senior citizens treated with them in relation to senior citizens who aren’t.