A recent study was published in the Journal of the American Medical Directors Association that explored whether the effects of depressive symptoms and antidepressant use at baseline predicted the subsequent decline in physical capability and number of hospitalizations in nursing home residents in Hong Kong. A supplement purpose was to understand the role of antidepressant use in preventing ADL (activities of daily living) decline and decreasing use of medical services. The study’s findings showed negative impact of depressive symptoms and indicated an important role of antidepressant use in altering the trajectory of physical recession.
Depression is a debilitating psychological illness that is prevalent in the older adult population living in long-term care settings. According to a report from the Journal of the American Medical Directors Association (JAMDA), older adult residents in long-term care are 3 to 4 times more likely to have depression compared to their community-dwelling counterparts.
Older adults living in assisted living facilities often require assistance with medication management. A recent study analyzed the roles in assisted living medication management and satisfaction with unlicensed assisted personnel (UAP) as medication aides, a commonly used approach to decrease staffing expenses. The results of the study detail medication management roles, empirical confirmation of existing assisted living nursing profession standards, and satisfaction with the role of UAP as medication aide from all perspectives. A few clinical implications from the study were creating a supportive environment for medication aides (i.e., UAPs), the significance of the role of the Registered Nurse as a facilitator of assisted living medication management, and the necessity for collaboration and interprofessional team development across various settings.
The older population is steadily growing worldwide. The aging process often involves a continuous decline in cognitive function, normally leading to minor changes to cognitive processes such as memory retrieval and the speed at which information is encoded. For normal progression of aging, this functional decrease is not critical enough to have any debilitating effect on average daily activities. In cases where the decline is more significant, dementia, delirium, and depression can develop. Antidepressants are often used for the treatment of depression and dementia, but there is limited evidence showing that this type of pharmacotherapy is effective. Moreover, the prescription of these drugs often results in about half the patients experiencing recurrence of the original symptoms. Notwithstanding these uncertain results, attending physicians still rely on antidepressants as a standard option and prescribe them to 43.2% of patients with dementia and depression.
Many older adults who suffer from cognitive disability also display challenging or problem behaviors. These types of behaviors threaten the physical safety of the individuals or others or cause community facilities to become inaccessible. There has been much concern for many years regarding the use of psychotropic drugs—specifically, antipsychotics—that are used inappropriately in patients with cognitive disability and that are often prescribed solely for challenging behavior rather than for diagnosed cognitive illness, despite lack of substantial evidence.
The prescription of potentially inappropriate medications to older adults is known to be highly prevalent in the United States, estimating from 12% for community-living seniors to 40% for those dwelling in nursing homes (NHs). When prescribed drugs are clearly indicated, founded on scientific evidence, and are well tolerated, medication use is considered beneficial. Medications that are inappropriately prescribed often lead to negative health consequences. Furthermore, age-related physiological changes may influence the change of pharmacokinetic and pharmacodynamics responses to medications, further decreasing the tolerability of many medications in older adults.
Research shows that nearly 80% of nursing home residents have osteoporosis and 10.8% have a hip fracture. Dementia significantly increases residents’ risk of a hip fracture. Although treating osteoporosis in nursing homes was proven to be feasible by the Vitamin D and Osteoporosis Study (ViDOS), only one-third of residents prone to hip fracture were treated. Moreover, a number of these residents were given calcitonin or raloxifene, which are not as effective as alendronate or zolendronic acid.
It has taken far too long, but the Obama administration is finally cracking down on nursing homes to curtail inappropriate use of antipsychotic medications such as Abilify, Risperdal, Zyprexa, and clozapine on residents with Alzhiemer’s disease and dementia. Federal investigators report that many older Americans are overusing psychiatric drugs and recommend that Medicare officials stop making unnecessary prescriptions immediately
This November, there will be an important proposition on the ballot that all advocates of older adults should be aware of. The Troy and Alana Pack Patient Safety Act, also known as Proposition 46, is a ballot initiative that will protect patients from corporate greed in healthcare services. It is imperative that anyone concerned with elder abuse vote Yes on Proposition 46.
Proposition 46 will accomplish three things: 1) require health care providers to check a uniform database before prescribing medication to prevent drug abuse; 2) require doctors to take a drug and alcohol test; and 3) increase the limits on noneconomic damages for medical malpractice cases.
Older adults take many prescription medications. National Institute on Drug Abuse states that, older adults make up more than a third of all outpatient prescription medication cost even though they are a minority of the general population. California currently has a database that monitors how medication is prescribed and dispensed to prevent various types of drug abuse. This is called the CURES program, or Controlled Substance Utilization Review, and is administered by the Department of Justice. Proposition 46 mandates that physicians and pharmacists check CURES before prescribing or dispensing medication. Doctors would be advised through CURES about existing prescription, especially for strong painkillers (such as Vicodin and OxyContin) that carry a high risk of abuse.
According to the New York Times, the federal government will be implementing significant changes to the rating system of nursing homes in the United States. Currently, the ratings are based on a five star system that is scrutinized by the public. This five star rating system “has been criticized for its reliance on self-reported, unverified data.” The current system was implemented five years ago and evaluates staffing levels and quality of care, which is reported by the nursing homes and not audited by the federal government. This flawed rating system “relied heavily on unverified and incomplete information that even homes with a documented history of quality problems were earning top ratings.” In 2009 37% of nursing homes had ratings of four or five stars and by 2013 over 50% had exceedingly high ratings. With more than 15,000 nursing homes in the United States, it is crucial that the optimal quality of care is guaranteed by skilled nursing facilities. Continue reading