Blog post by Joe Babaian

Kindness can transform someone’s dark moment with a blaze of light. You’ll never know how much your caring matters. Make a difference for another today.

― Amy Leigh Mercree

Talking about dementia, elder care, and the journey toward the end of life is not easy but it doesn’t have to be ugly. I’m a firm believer in the power of knowledge, collaboration, and hope. Amy Mercree’s quote above really sums it up. My late mom’s birthday is coming up on Oct 20th – this terrible affliction robbed her from us and it still hurts.

This week on #hcldr I want to jump into a topic that is tough to process but must not be looked away from. It’s a difficult discussion and I am certain we can share both professional and personal insights to delve deeper. I just re-read the report “They Want Docile” by Human Rights Watch.  Not an easy read, but a critical one. Telling is the subtitle of the report: How Nursing Homes in the United States Overmedicate People with Dementia. 

Everyone knows about the problem and many have solutions but we don’t have a unified, national solution to a problem that extends beyond just the dangers of over-medication or polypharmacy in the elderly. We need to bring together the brightest voices with solutions and match them with the hardest hit and vulnerable parts of our population – the elderly and especially the elderly at risk with dementia, Alzheimer’s, multiple comorbidities, and other impairments.

A worrying trend is mentioned by Lisa Esposito in “Deprescribing Medications for Older Adults” from U.S. News and World Report:

More than one-third of U.S. adults in their early 60s and beyond take at least five prescription medications, according to a review article in the July 2017 issue of the Journal of Family Practice. The study, led by Dr. Kathryn McGrath, a geriatrician and an assistant professor affiliated with Thomas Jefferson University Hospitals in Philadelphia, gives healthcare providers a roadmap for deprescribing.

This trend is showing no signs of abating and, in fact, the Newcastle University Institute for Aging has found:

The number of older people with four or more chronic diseases is expected to nearly double by 2035.

This type of evidence can’t be dismissed and now is the time for action.

Something we all take for granted, informed consent, is also not often present in nursing homes. Hannah Flamm in “Why are nursing homes drugging dementia patients without their consent?” discusses:

The way nursing homes obtain or define “informed consent” can also be a factor in the drugs’ misuse. “The use of specific medicines, particularly for somebody with dementia, who lacks the capacity to consent themselves, should require informed consent from their legal representative,” says Jonathan Evans, a former president of the American Medical Directors Association. “But in practice that seldom happens. Not just for that medicine but for any medicine.”

Let’s take a moment to consider this topic and share experiences, solutions, problems that can be solved together, and hope for the future of these at-risk populations. People, plain and simple.

Please join me on Tuesday, October 18th at 8:30pm ET for the weekly #hcldr tweetchat where we will be discussing Dementia and Healthcare’s Dilemma:

• T1: How has dementia or Alzheimer’s impacted you or your family?

• T2: What must we do to improve institutionalized elder care (skilled nursing, LTAC, etc.) to counter devastating outcomes such as overmedication and abuse?

• T3: Please share some examples of better outcomes for elder care both in a home-based environment and within a facility.

• T4: How should healthcare respond to the ongoing wave of an aging population with multiple comorbidities?

References

Clague, F., Mercer, S. W., McLean, G., Reynish, E., & Guthrie, B. (2017). Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data. Age and Ageing, 46(1), 33–39. https://doi.org/10.1093/ageing/afw176

Deprescribing Medications for Older Adults. (n.d.). https://health.usnews.com/health-care/patient-advice/articles/2018-01-17/deprescribing-medications-for-older-adults

Human Rights Watch. (2018, February 5). “They Want Docile” | How Nursing Homes in the United States Overmedicate People with Dementia. https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia

Lau, D. T., Mercaldo, N. D., Harris, A. T., Trittschuh, E., Shega, J., & Weintraub, S. (2010). Polypharmacy and Potentially Inappropriate Medication Use among Community-Dwelling Elders with Dementia. Alzheimer Disease and Associated Disorders, 24(1), 56–63. https://doi.org/10.1097/WAD.0b013e31819d6ec9

Nørgaaard, A., Jensen-Dahm, C., Gasse, C., Wimberley, T., Steno, H. E., & Gunhild, W. (2017). Mortality risk associated with psychotropic polypharmacy in patients with dementia. Journal of the Neurological Sciences, 381, 1028. https://doi.org/10.1016/j.jns.2017.08.2902

Nørgaard, A., Jensen-Dahm, C., Gasse, C., Hansen, E. S., & Waldemar, G. (2017). Psychotropic Polypharmacy in Patients with Dementia: Prevalence and Predictors. Journal of Alzheimer’s Disease, 56(2), 707–716. https://doi.org/10.3233/JAD-160828

Number of older people in England with four or more diseases will double by 2035, say researchers — ScienceDaily. (n.d.).  https://www.sciencedaily.com/releases/2018/01/180123101919.htm

Older patients with 4+ chronic diseases expected to double by 2035. (n.d.). http://www.cardiovascularbusiness.com/topics/vascular-endovascular/elderly-patients-4-or-more-chronic-diseases-expected-double-2035

Park, H.-Y., Park, J.-W., Song, H. J., Sohn, H. S., & Kwon, J.-W. (2017). The Association between Polypharmacy and Dementia: A Nested Case-Control Study Based on a 12-Year Longitudinal Cohort Database in South Korea. PLoS ONE, 12(1). https://doi.org/10.1371/journal.pone.0169463

Perspective | Why are nursing homes drugging dementia patients without their consent? (n.d.). https://www.washingtonpost.com/outlook/2018/08/10/8baff64a-9a63-11e8-8d5e-c6c594024954_story.html

Schüssler, S., & Lohrmann, C. (2017). Dementia in Nursing Homes. Springer.

The Never-Ending Misuse of Antipsychotics In Nursing Homes | Health Affairs. (n.d.). https://www.healthaffairs.org/do/10.1377/hblog20180424.962541/full/