Good News about Medications for Dementia

                                          

I am pleased to introduce you to Rachel Wynn, MS CCC-SLP is speaker, writer, activist, and speech-language pathologist specializing in geriatric care. I invited her to share some of her thought about about medications and dementia.  She blogs at Gray Matter Therapy, which strives to provide information about geriatric care including functional treatment ideas, recent research, and ethical care. Find her on Facebook, Twitter, or hiking with her dog in Boulder, CO.

 

Let me just state my bias up front. In my personal life, I avoid taking medications. Rather than take pain reliever for a headache, I drink water. The headache is likely due to dehydration (which is common at high altitude) or sinus distress (and water thins mucous being produced). I avoid medications, but I am not anti-medications. In fact, I take a medication every day and will likely for the rest of my life, because my body requires it. Personally, I believe medications aren’t often necessary, especially as the first intervention.

 

As a speech-language pathologist, it is not within my scope of practice to give recommendations regarding medications. However, it is within my scope of practice to understand how medications affect the body, especially when there may be side effects impacting cognition or swallowing.

 
Medications but no therapy?

One of the things I have found quite concerning is meeting someone new to my care community and seeing the list of medications they are on. They may be on a cholinesterase inhibitor and antipsychotic medications for dementia, but they have never participated in any therapy (speech-language pathology, occupational therapy, or neuropsychology). This is concerning, because there are so many benefits to therapy throughout the course of dementia.

 

In the earlier stages, therapists develop individualized compensatory strategies and routines to help people maintain their independence as long as possible. In the middle to late stages of dementia, therapists work on changing the environment to increase a person’s independence and quality of life. These interventions don’t cure dementia (but neither do any of the current medications on the market); however, they are individualized to help improve quality of life, independence, and safety without side effects.

Antipsychotic medication effects in the elderly

Antipsychotic medications are not without side effects. Common side effects of antipsychotics in the elderly include [1]:

• anticholinergic reactions
• parkinsonian events
• tardive dyskinesia
• orthostatic hypotension
• cardiac conduction disturbances
• reduced bone mineral density
• sedation
• cognitive slowing

We rightfully spend great time and energy on fall prevention efforts. How many of those antipsychotic side effects would contribute to an increased risk for falls? Most of them. Besides falls, in people with dementia sedation and cognitive slowing would complicate matters. Yet, these are very common side effects.

 
CMS sets goal to move away from antipsychotics

Given my stance on medication, especially in the treatment of dementia, I was very pleased to see this press release from the Centers for Medicare & Medicaid Services [2]. The press release states the goal CMS set to reduce use of antipsychotic medications in nursing homes by 25% by the end of 2015 and 30% by the end of 2016. This is excellent news.

 

Want even better news? Patrick Conway, MD and CMS chief medical officer said, “In partnership with key stakeholders, we have set ambitious goals to reduce use of antipsychotics because there are - for many people with dementia - behavioral and other approaches to provide this care more effectively and safely.” (emphasis mine).

 

As an advocate for person-centered healthcare, Dr. Conway’s words make my heart happy. He said, “Ultimately, nursing homes should re-think their approach to dementia care, reconnect with the person and their families, and use a comprehensive team-based approach to provide care.”

 

Way to go CMS! Now let’s chat about how CMS reimburses for these therapy services that can achieve excellent results without the side effects of antipsychotic medications…

 

References:

1. Masand, P.S. (2000). Side effects of antipsychotics in the elderly. Journal of Clinical Dementia Care Exceeds Goal to Reduce Use of Antipsychotic Medications in Nursing Homes: CMS Announces New Goal. Newsroom Center. CMS.gov, 19 Sept. 2014. Web. 19 Sept. 2014.Psychiatry, 60(8), 43-49.
2. Centers for Medicare & Medicaid Services. National Partnership to Improve