presented by Elizabeth Galik
Antipsychotic medications have been widely used to manage behavioral symptoms among older adults with dementia. The Centers for Medicare and Medicaid have launched a policy initiative to decrease the inappropriate use of antipsychotics in long-term care settings due to minimal effectiveness and risks associated with their use. Antipsychotic use now affects nursing homes’ five-star quality rating score. This session will describe the appropriate use of antipsychotics and help nurses to monitor for potential side effects of these medications. Additionally, common challenges and practical solutions for antipsychotic reduction in long-term care settings will be discussed.
Elizabeth Galik is a Professor at the University of Maryland School of Nursing. She received a BSN from the University of Pennsylvania, an MSN from Villanova University, a post-master's Adult Nurse Practitioner Certificate from Johns Hopkins University, and a PhD from the University of Maryland. Her research interest is in developing and testing interventions to improve functional performance, physical activity, and quality of life among older adults with dementia. Dr. Galik practices clinically as a nurse practitioner in community and long-term care settings and focuses on the medical and neuropsychiatric care of individuals with dementia. In addition to her research, she also teaches in the adult and geriatric nurse practitioner program. Dr. Galik was awarded a John A. Hartford Foundation pre-doctoral fellowship, and has received extramural research funding from the Alzheimer's Association, Foundation of the American Medical Directors’ Association, and the American Academy of Nurse Practitioners. She is a Board Member of the Maryland Gerontological Association, and the President Elect for the Gerontological Advanced Practice Nurses Association. Her memberships include Sigma Theta Tau International, Phi Kappa Phi, Southern Nursing Research Society, Gerontological Association of America, and the American Academy of Nurse Practitioners.
This chapter will describe the prevalence of antipsychotic use among older adults. Additionally, approved uses of antipsychotics per the Food and Drug Administration (FDA) will be reviewed as well as off-label uses. This is important because the prevalence of antipsychotic use is moderate among older adults in long-term care settings, and most antipsychotics are prescribed for off-label uses.
This chapter will describe the potential benefits and risks associated with antipsychotic use among older adults, particularly those individuals with dementia. Antipsychotics have evidence of efficacy when used to treat schizophrenia and bipolar disorder and may have limited efficacy when used for psychotic symptoms and physically aggressive symptoms in the context of dementia.There are numerous potential side effects associated with antipsychotics that may negatively impact health and function, including increased risk of death among older adults with dementia.
This chapter will describe the potential challenges and practical solutions associated with the gradual dose reduction of antipsychotics in long-term care settings. Potential challenges that will be discussed include: silo approach to care, misunderstanding of the Centers for Medicare and Medicaid regulation regarding the use of antipsychotics, unfamiliarity with assessment tools to monitor antipsychotic use, and gradual dose reduction of antipsychotics. It is done without emphasis on the use of nonpharmacological approaches to management of behavioral symptoms.
This chapter will discuss a five-step approach for successfully reducing the inappropriate use of antipsychotics in the long-term care setting. This five-step approach can be utilized in any long-term care setting and will help your facility remain in compliance with the Centers for Medicare and Medicaid regulation, F-Tag 329.