Dementia and Antipsychotic Drugs - Assignment Example

Dementia and Antipsychotic Drugs Dementia and Antipsychotic Drugs Introduction Research reveals that up to 90% of individuals with dementia experience behavioral and psychological changes that manifest themselves as a result of their condition. These symptoms can be managed without the use of medication, but further research shows that nursing homes continually misuse antipsychotic drugs to manage the symptoms. Some of the symptoms associated with dementia include aggression, psychosis and agitation, and it can be shown that different states prescribe antipsychotic drugs to manage these symptoms. For example, an audit by the Inspector General in 2011 revealed that more than 80% of the Medicare requests were for the prescription of antipsychotic drugs for invalid or unapproved conditions such as dementia. The state of Connecticut ranked among the top four in prescribing these drugs to patients without confirmed or approved conditions, and also ranked second in administering the drugs to high risk individuals with dementia (Barnes, Veith, Okimoto, Raskind, & Gumbrecht, 2002). Despite recent efforts to curb the misuse of antipsychotic drugs in patients with dementia, Connecticut still has a high prevalence rate, with 25% of nursing home inmates receiving the drugs. Different groups in the state have come together to try reduce the misuse of these drugs in patients with dementia, which is done by the education of nursing homes to offer other means of managing dementia solutions. However, the best policy that works around the issue was an amendment introduced to curb the use of antipsychotic drugs in managing dementia symptoms. The amendment focuses on Section 3604 of the Food and Drug Administration Safety and Innovation Act and seeks to ensure that approval is sought before antipsychotic drugs are given to patients with dementia. From the policy, it is stated that nursing home providers must seek approval from the patient, representatives or agents before the drugs are used. Additionally, the nursing homes are mandated to disclose the possible side effects and risks associated with the prescription of antipsychotic drugs in the treatment or management of dementia (GovTrack, 2013). Literature Review A review of literature on the use of antipsychotic drugs reveals a high prevalence of the said factor in the United States. When cases of dementia are diagnosed, the physician has to first eliminate other treatment options for the symptoms before antipsychotic drugs are prescribed. However, for some symptoms such as restlessness and aggression, it has been noted that nursing home providers decide to apply antipsychotic medication to calm the patients without considering other forms of treatment. Estimates indicate that many physicians use antipsychotic drugs with dementia patients as a first resort without considering other non-drug ways of managing the symptoms. One of the main concerns that research shows is that there are cases of overprescriptions in nursing homes – a fact that can be attributed to the symptomatic behavior of the patients. With the new policy on the use of antipsychotic drug to manage dementia patients, the number of patients prescribed with antipsychotic medication to manage their symptoms is expected to reduce significantly. Snowden, Sato and Roy-Byrne (2003) indicate that the training and education accorded to health and nursing home providers will be effective in reducing cases of improper prescriptions of antipsychotic drugs to dementia patients. Furthermore, it can be shown that the claims from Medicare for antipsychotic drugs, especially atypical drugs, have been on the increase, and close investigation revealed that the claims were not warranted. In most of the cases, the dementia symptoms could well be managed without the use of any medication. One of the main concerns with the prescription of antipsychotic drugs to patients with dementia is that they are prone to adverse effects of the drugs. According to Schneider, Karen, Dagerman and Philip (2005), dementia patients are exposed to the risk of death when antipsychotic drugs are prescribed as a means of curbing their symptoms. According to the researchers, there is an increased risk of up to7% of death in patients who are exposed to antipsychotic drugs as a means of treating the symptoms of dementia instead of using non-drug methods (Schneider, Dagerman, & Insel, 2005). From a review of relevant literature, one of the main reasons that antipsychotic drugs are inappropriate for dementia patients is the possibility of adverse effects (Sink, Holden, & Yaffe, 2005). Studies show that there are increased chances of excessive sedation, dizziness and increased chances of strokes when antipsychotic drugs are prescribed as a means of managing the symptoms of dementia in elderly individuals. This means that the risk of mortality is significantly increased when these drugs are used with dementia patients. Studies also indicate that the lack of information and education among nursing and care staff leads to the prescription of antipsychotic drugs for dementia patients. Most of the behavioral and psychological symptoms expressed by individuals with dementia, such as aggression and shouting, can be attributed to unmet needs, and training of care providers would provide solutions other than the use of antipsychotic drugs (Snowden et al., 2003). Instead of prescribing the drugs as a quick means of managing behavior, nursing homes should look for ways of providing other means of support to their patients, i.e., ways that are effectively drug-free. Research also indicates that the use of antipsychotic drugs is not altogether effective since the drugs only have modest benefits and do not work as a permanent solution to the symptoms (Fossey et al., 2006). Pursuant to this fact, the use of antipsychotic drugs is only recommended for up to six weeks, after which alternative ways of resolution have to be sought. Despite this fact, it is still noted that nursing homes use the drugs as a somewhat permanent solution to dementia patient symptoms. One of the factors associated with the use of antipsychotic drugs as a means of managing dementia is the cost attached. According to Raskind, Risse and Lampe (1987), behavioral intervention as opposed to the use of antipsychotic drugs to manage dementia symptoms is a very effective means of reducing attached costs. Antipsychotic drugs are very expensive to procure and use, as indicated by the claims posted on Medicare by nursing homes for the elderly living with dementia. One of the most effective non-drug related interventions is the use of cognitive simulation therapy, which is far much cost-effective than the use of antipsychotic drugs, and helps reduce the attached cost. From the onset, the cost of behavioral treatment for dementia symptoms is higher than the cost of using antipsychotic drugs, but due to the effects of the drugs, the overall cost estimates change (Liperoti, Pedone, & Corsonello, 2008). For example, most patients who use antipsychotic drugs are prone to strokes and other side effects, whose cost of treatment far outweighs the cost of behavioral therapy. This means that in overall, it is better to use behavioral therapy to manage patients with dementia. Policy Significance Due to the prevalence of misuse of antipsychotic drugs in the treatment of dementia cases, three senators introduced a bill that seeks to regularize the use of antipsychotic drugs in the management of dementia cases. The bill, called the Improving Dementia Care Treatment for Older Adults Act, was introduced in the Senate by Blumenthal Kohl and Grassley to address the growing concerns of abuse of antipsychotic drugs in treatment of dementia symptoms in nursing homes for the elderly. According to O’Sullivan (2013), more than 25% of all patients in nursing homes receive antipsychotic drugs while up to 40% of dementia patients receive antipsychotic drugs despite the availability of other means of managing their symptoms. The Food and Drugs Administration prohibits the use of antipsychotic drugs in the management of dementia symptoms, but many nursing homes still prescribe them to manage their patients. Research indicates that the prescription of antipsychotic drugs to patients has different health risks, including but not limited to strokes, oversedation and loss of independence. Furthermore, the FDA issued blanket black box warnings over the use of antipsychotic drugs in the management of dementia patients, stating that these patients are at an increased risk of dying from the administration of these drugs (Gill, Bronskill, & Normand, 2007). The main significance of the policy is seen from the main facts including the fact that nursing homes now require informed consent from the patient before the drugs are administered. By informed consent, the policy means that the patient or their legal representative must be informed of the risks and potential side effects of using the drugs to manage the symptoms of dementia. Before the introduction of the policy, patients would be administered without knowing the potential results or effects of the drugs. Mainly, the drugs would be dangerous to the patient, but since the prescribers would not reveal this information, the drugs were abused. In fact, many patients or representatives would not agree to the prescriptions if they knew the potential side effects. With the new policy, the patients are accorded the right to know the drugs they are taking and the potential effects of the drugs. Therefore, the misuse of the antipsychotic drugs would be curtailed. The other significance of the policy comes in the education of care providers for patients with dementia. Before the introduction of the policy, nursing home providers did not know about other effective methods of managing dementia symptoms, and only resorted to the use of antipsychotic drugs as a means of curbing the symptoms. With the new policy, the physicians and other health providers, who are not aware of other highly effective means of managing dementia, are educated. For example, it has been shown that dementia patients can easily be managed without using drugs. The policy requires that education programs be set up to inform the physicians about other means of treating dementia, including information on better treatments or non-drug intervention for managing dementia and proper medication. The policy also requires nursing homes catering for the elderly with dementia to constantly review monthly reports on the use of antipsychotic drugs and gauge themselves on their utilization rates. With this, the nursing homes would be able to know if they are misusing antipsychotic drugs in the treatment of cases that would otherwise have been managed better. One other fact that should be noted is that the use of antipsychotic drugs to manage dementia symptoms is very costly – a fact that the policy introduced in 2012 seeks to address. From research, it is evident that the antipsychotic drugs are extremely costly, with costs running up to billions of dollars for Medicaid and Medicare programs in the country. With the introduction of the new policy, these costs can be reduced and the money channelled to serve better purposes in the health care sector. Data from the Department of Health and Human Services indicate that more than 50% of antipsychotic medication claimed and paid for was for wrong or unnecessary prescriptions, and with the introduction of the new policy, this figure significantly reduced. From the above research, it can be deduced that the policy introduced as a bill in the Senate would be very effective in managing the misuse of antipsychotic drugs in the management of dementia cases and symptoms. Summary From the discussion above, it is evident that the use of antipsychotic drugs in the management of dementia and its symptoms is not effective and has more adverse effects than positive ones. The policy introduced in the state of Connecticut is effective in ensuring that antipsychotic drugs are not misused in application to dementia patients. One of the key factors of the policy is the need to inform the patient or their legal representative of the potential effects of using antipsychotic drugs to manage the condition. With this information, the misuse reduces since patients learn of the potential adverse effects of using antipsychotic drugs. One other important fact is that health care providers are educated on other means of managing the condition, and they do not have to rely solely on antipsychotic drugs. Overall, the policy is effective in ensuring that patients are accorded the right health care with regard to the treatment of dementia. References Barnes, R., Veith, R., Okimoto, J., Raskind, M., & Gumbrecht, G. (2002). Efficacy of antipsychotic medications in behaviorally disturbed dementia patients. Am J. Psychiatry, 239(9), 1170–174. Fossey, J., Ballard, C., Juszczak, E., James, I., Alder, N., Jacoby, R., & Howard, R. (2006). Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: Cluster randomised trial. BMJ, 332, 756–761. Gill, S., Bronskill, S. E., &Normand, S. (2007). Antipsychotic drug use and mortality in older adults with dementia. Annals of Internal Medicine, 146(11). GovTrack.US. (2013). S. 3604 (112th): Improving Dementia Care Treatment for Older Adults Act of 2012. Liperoti, R., Pedone, C., & Corsonello, A. (2008). Antipsychotics for the treatment of behavioral and psychological symptoms of dementia (BPSD). Curr Neuropharmacol, 6, 117–124. OSullivan, G. (2013). Ethical and effective: Approaches to residential care for people with dementia. Dementia, 12(1), 111–121. Raskind, A., Risse, C., & Lampe, T. H. (1987). Dementia and antipsychotic drugs. Journal of Clinical Psychiatry, 48(5), 16–18. Schneider, L. S., Dagerman, S. K, & Insel, P. (2005). Risk of death with atypical antipsychotic drug treatment for dementia. JAMA, 295(15), 1934–1943. Sink, K. M., Holden, K. F., & Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: A review of the evidence. JAMA, 293, 596–608. Snowden, M., Sato, K., & Roy-Byrne, P. J. (2003). Assessment and treatment of nursing home residents with depression or behavioral symptoms associated with dementia: A review of the literature. Am Geriatr Society, 51(9), 1305–1317. Read More