Judith Lucas at Health Affairs Briefing panel discussion. Courtesy of Health Affairs.
The aging of the American population over 65 years old is expected to reach 84 million by 2050. Gerontology experts gathered at our nation’s capitol to address challenges of care delivery at end of life, financing and spending, quality of care and patient preferences and hospice and palliative care during a Health Affairs Briefing: Advanced Illness and End-of-Life Care at the National Press Club in Washington, D.C. on July 11.
Among the journal authors presenting was College of Nursing Associate Professor Judith A. Lucas, Ed.D., APRN, GCNS-BC, who shared results of research she undertook with colleague John R. Bowblis of Miami University in Oxford, Ohio. Their research explored CMS (Centers for Medicare and Medicaid Services) Strategies to Reduce Antipsychotic Drug Use in Nursing Home Patients With Dementia Show Some Progress. Professor Lucas’ study was published in the July issue of Health Affairs as part of Health Affairs’ Aging & Health series, which is supported by The John A. Hartford Foundation. Health Affairs is the leading peer-reviewed journal at the intersection of health, health care and policy.
Professor Lucas has devoted more than 30 years to issues related to geriatric populations living in community home care, assisted living and nursing homes (NH). She served on a panel of Geriatric Nursing experts in a CMS Partnership to improve dementia care in nursing homes, and continues her significant research on the inappropriate use of antipsychotic medications in dementia care, utilizing and analyzing national data on federal policy changes to address the targeted strategies implemented by CMS since 2012 to reduce these medications.
Judith Lucas presents her research at Health Affairs briefing. Courtesy of Health Affairs.
Lucas explained that the CMS Partnership implemented three strategies to improve care and reduce unnecessary use of antipsychotics: forming a public-private partnership to improve dementia care, public reporting data on use of antipsychotic use, updating federal survey and certification standards that regulate care with required instruction to state surveyors to clarify when to give deficiency citations during recertification surveys for non-compliance with quality of care and unnecessary drug use standards.
Their research examined 86,163 nursing home recertifications in 15,055 unique facilities around the nation between January 1, 2009 to March 31, 2015. They wanted to determine if there were changes in the number of deficiencies issued and the prevalence of antipsychotic use associated with the strategies. They also wanted to examine the prevalence of other psychoactive medications that may be substituted for antipsychotics to comply with CMS efforts.
“We found that recent CMS efforts to reduce antipsychotic use in nursing homes are starting to have their intended effect. Even a modest reduction in these drugs are a benefit to nursing home residents with dementia, saving between 327 to 655 lives per year in addition to potential savings of Medicare spending on antipsychotics,” she explained.
Dementia touches many families. Causes of dementia include strokes, brain injury, Parkinson’s Disease and Alzheimer’s, producing neuro cognitive changes. The U.S. Food and Drug Administration (FDA) does not have a medication approved to treat behavioral symptoms of dementia. Many people with dementia experience distressing behaviors and psychological symptoms (BPSD) so in nursing home settings they often are medicated with antipsychotics to sedate them, which some consider a form of “chemical restraint.” This unnecessary medication increases the risk of mortality and such negative outcomes as falls, hip fractures, pneumonia and strokes.
The study results highlighted one concern, a small but consistent increase of other psychoactive drugs prescribed to patients. The overall use of these medications causes high psychoactive drug burden and needs future study and enforcement. Continuous CMS monitoring, training and consistent enforcement are needed to continue reducing unnecessary use of antipsychotics and other psychoactive medications in nursing homes.
“We live is a culture that prescribes medications where we treat everyone similarly, not person-centered. We need to individualize care and change the culture in nursing homes,” said Lucas.
Lucas encourages others to join her and make a difference.
“Nurses of all types really have an opportunity to get to know patients and really work with their families and caregivers. It is very rewarding to work with older adults. They really appreciate any attention and care provided to them. Nursing is a wonderful field to work in and we can have an impact on both quality of care and quality of life for older adults. As the population ages, we need more nurses skilled in gerontology,” she added.
To learn more about the study, read http://content.healthaffairs.org/content/36/7/1299.abstract.
To watch the archived stream of the briefing, visit http://www.healthaffairs.org/events/2017_07_11_advanced_illness_end_of_life_care.
Categories: Health and Medicine