Background and Objectives: Antipsychotic medications have been widely used in nursing homes to manage behavioral and psychological symptoms of dementia, despite significantly increased mortality risk. Use grew rapidly during the 2000s, reaching 23.9% of residents by 2011. A national campaign for safer dementia care in U.S. nursing homes was launched in 2012, with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. By the second quarter of 2019, use had declined by 40.1% to 14.3%. We assessed the impact of state and facility initiatives during the Campaign aimed at encouraging more-judicious prescribing of antipsychotic medications. Research Design and Methods: Our mixed-methods strategy integrated administrative and clinical data analyses with state and facility case studies. Results: Results suggest that substantial change in prescribing is achievable through sustained, data-informed quality improvement initiatives integrating educational and regulatory interventions, supported by public quality reporting. Adequate staffing, particularly of registered nurses, is key to support individualized management of symptoms through nonpharmacological strategies. Case study results suggest that state and facility initiatives during the campaign achieved considerable buy-in for the goal of more conservative prescribing, through a social process of normalization. Reporting and reduction of antipsychotic use was not followed by increases in sedative-hypnotic medication use. Rather, sedative-hypnotic use declined in tandem with antipsychotic reduction, suggesting that increased attention to prescribing patterns led to more cautious use of other risky psychotropic medications. Discussion and Implications: Quality improvement initiatives to change entrenched but problematic clinical practices face many barriers to success, including provider-level inertia; perceptions that alternatives are not available; and family and staff resistance. Nevertheless, systemic change is possible through concerted, collaborative efforts that touch prescribing practices at multiple points; integrate educational and regulatory influences; activate local and state champions for improvement; foster reputational influences through public reporting and benchmarking; and support a social process of normalization of preferred care processes as a best practice that is in the interest of patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1-13 |
| Number of pages | 13 |
| Journal | Innovation in Aging |
| Volume | 4 |
| Issue number | 3 |
| DOIs | |
| State | Published - 2020 |
- Health(social science)
- Health Professions (miscellaneous)
- Life-span and Life-course Studies
- Alzheimer's disease and related dementias
- Antipsychotics
- Chemical restraints
- Sedative-hypnotics
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver
Crystal, S., Jarrín, O. F., Rosenthal, M., Hermida, R., & Angell, B. (2020). National partnership to improve dementia care in nursing homes campaign: State and facility strategies, impact, and antipsychotic reduction outcomes. Innovation in Aging, 4(3), 1-13. https://doi.org/10.1093/geroni/igaa018
Crystal, Stephen ; Jarrín, Olga F. ; Rosenthal, Marsha et al. / National partnership to improve dementia care in nursing homes campaign : State and facility strategies, impact, and antipsychotic reduction outcomes. In: Innovation in Aging. 2020 ; Vol. 4, No. 3. pp. 1-13.
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title = "National partnership to improve dementia care in nursing homes campaign: State and facility strategies, impact, and antipsychotic reduction outcomes",
abstract = "Background and Objectives: Antipsychotic medications have been widely used in nursing homes to manage behavioral and psychological symptoms of dementia, despite significantly increased mortality risk. Use grew rapidly during the 2000s, reaching 23.9% of residents by 2011. A national campaign for safer dementia care in U.S. nursing homes was launched in 2012, with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. By the second quarter of 2019, use had declined by 40.1% to 14.3%. We assessed the impact of state and facility initiatives during the Campaign aimed at encouraging more-judicious prescribing of antipsychotic medications. Research Design and Methods: Our mixed-methods strategy integrated administrative and clinical data analyses with state and facility case studies. Results: Results suggest that substantial change in prescribing is achievable through sustained, data-informed quality improvement initiatives integrating educational and regulatory interventions, supported by public quality reporting. Adequate staffing, particularly of registered nurses, is key to support individualized management of symptoms through nonpharmacological strategies. Case study results suggest that state and facility initiatives during the campaign achieved considerable buy-in for the goal of more conservative prescribing, through a social process of normalization. Reporting and reduction of antipsychotic use was not followed by increases in sedative-hypnotic medication use. Rather, sedative-hypnotic use declined in tandem with antipsychotic reduction, suggesting that increased attention to prescribing patterns led to more cautious use of other risky psychotropic medications. Discussion and Implications: Quality improvement initiatives to change entrenched but problematic clinical practices face many barriers to success, including provider-level inertia; perceptions that alternatives are not available; and family and staff resistance. Nevertheless, systemic change is possible through concerted, collaborative efforts that touch prescribing practices at multiple points; integrate educational and regulatory influences; activate local and state champions for improvement; foster reputational influences through public reporting and benchmarking; and support a social process of normalization of preferred care processes as a best practice that is in the interest of patients. ",
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Crystal, S, Jarrín, OF, Rosenthal, M, Hermida, R & Angell, B 2020, 'National partnership to improve dementia care in nursing homes campaign: State and facility strategies, impact, and antipsychotic reduction outcomes', Innovation in Aging, vol. 4, no. 3, pp. 1-13. https://doi.org/10.1093/geroni/igaa018
National partnership to improve dementia care in nursing homes campaign : State and facility strategies, impact, and antipsychotic reduction outcomes. / Crystal, Stephen; Jarrín, Olga F.; Rosenthal, Marsha et al.
In: Innovation in Aging, Vol. 4, No. 3, 2020, p. 1-13.
Research output: Contribution to journal › Article › peer-review
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T2 - State and facility strategies, impact, and antipsychotic reduction outcomes
AU - Crystal, Stephen
AU - Jarrín, Olga F.
AU - Rosenthal, Marsha
AU - Hermida, Richard
AU - Angell, Beth
N1 - Publisher Copyright: © 2020 The Author(s) 2020.
PY - 2020
Y1 - 2020
N2 - Background and Objectives: Antipsychotic medications have been widely used in nursing homes to manage behavioral and psychological symptoms of dementia, despite significantly increased mortality risk. Use grew rapidly during the 2000s, reaching 23.9% of residents by 2011. A national campaign for safer dementia care in U.S. nursing homes was launched in 2012, with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. By the second quarter of 2019, use had declined by 40.1% to 14.3%. We assessed the impact of state and facility initiatives during the Campaign aimed at encouraging more-judicious prescribing of antipsychotic medications. Research Design and Methods: Our mixed-methods strategy integrated administrative and clinical data analyses with state and facility case studies. Results: Results suggest that substantial change in prescribing is achievable through sustained, data-informed quality improvement initiatives integrating educational and regulatory interventions, supported by public quality reporting. Adequate staffing, particularly of registered nurses, is key to support individualized management of symptoms through nonpharmacological strategies. Case study results suggest that state and facility initiatives during the campaign achieved considerable buy-in for the goal of more conservative prescribing, through a social process of normalization. Reporting and reduction of antipsychotic use was not followed by increases in sedative-hypnotic medication use. Rather, sedative-hypnotic use declined in tandem with antipsychotic reduction, suggesting that increased attention to prescribing patterns led to more cautious use of other risky psychotropic medications. Discussion and Implications: Quality improvement initiatives to change entrenched but problematic clinical practices face many barriers to success, including provider-level inertia; perceptions that alternatives are not available; and family and staff resistance. Nevertheless, systemic change is possible through concerted, collaborative efforts that touch prescribing practices at multiple points; integrate educational and regulatory influences; activate local and state champions for improvement; foster reputational influences through public reporting and benchmarking; and support a social process of normalization of preferred care processes as a best practice that is in the interest of patients.
AB - Background and Objectives: Antipsychotic medications have been widely used in nursing homes to manage behavioral and psychological symptoms of dementia, despite significantly increased mortality risk. Use grew rapidly during the 2000s, reaching 23.9% of residents by 2011. A national campaign for safer dementia care in U.S. nursing homes was launched in 2012, with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. By the second quarter of 2019, use had declined by 40.1% to 14.3%. We assessed the impact of state and facility initiatives during the Campaign aimed at encouraging more-judicious prescribing of antipsychotic medications. Research Design and Methods: Our mixed-methods strategy integrated administrative and clinical data analyses with state and facility case studies. Results: Results suggest that substantial change in prescribing is achievable through sustained, data-informed quality improvement initiatives integrating educational and regulatory interventions, supported by public quality reporting. Adequate staffing, particularly of registered nurses, is key to support individualized management of symptoms through nonpharmacological strategies. Case study results suggest that state and facility initiatives during the campaign achieved considerable buy-in for the goal of more conservative prescribing, through a social process of normalization. Reporting and reduction of antipsychotic use was not followed by increases in sedative-hypnotic medication use. Rather, sedative-hypnotic use declined in tandem with antipsychotic reduction, suggesting that increased attention to prescribing patterns led to more cautious use of other risky psychotropic medications. Discussion and Implications: Quality improvement initiatives to change entrenched but problematic clinical practices face many barriers to success, including provider-level inertia; perceptions that alternatives are not available; and family and staff resistance. Nevertheless, systemic change is possible through concerted, collaborative efforts that touch prescribing practices at multiple points; integrate educational and regulatory influences; activate local and state champions for improvement; foster reputational influences through public reporting and benchmarking; and support a social process of normalization of preferred care processes as a best practice that is in the interest of patients.
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Crystal S, Jarrín OF, Rosenthal M, Hermida R, Angell B. National partnership to improve dementia care in nursing homes campaign: State and facility strategies, impact, and antipsychotic reduction outcomes. Innovation in Aging. 2020;4(3):1-13. https://doi.org/10.1093/geroni/igaa018
FAQs
What percentage of NH patients have dementia? ›
Nationwide, there are more than 15,000 nursing homes and more than 28,000 assisted living communities. According to the Alzheimer's Association 2020 Alzheimer's Disease Facts and Figures report, 48% percent of nursing home residents are living with Alzheimer's or other dementias.
What are acceptable diagnosis for antipsychotics? ›Antipsychotic medications are used extensively in nursing homes. When used for approved disease states - such as schizophrenia, Huntington's disease and Tourette's syndrome - their clinical benefits are widely accepted.
Are antipsychotic medications indicated for the treatment of dementia related psychosis? ›Antipsychotic drugs may be prescribed for people with dementia who develop changes such as aggression and psychosis. However this is usually only after other drugs have been tried such as anti-depressant, anti-dementia and anticonvulsant drugs.
What country has the highest Alzheimer's rate? ›Finland. The country with the most cases of Alzheimer's Disease is Finland. There are 54.65 cases of Alzheimer's for every 100,000 people in this country. These numbers and statistics put Finland in the extremely high occurrence and high prevalence range for the disease.
What is the average age of dementia patients? ›About 3% of adults ages 70 to 74 had dementia in 2019, compared with 22% of adults ages 85 to 89 and 33% of adults ages 90 and older. Women are slightly more likely to have dementia than men. Among adults ages 70 and older, 11% of women and 8% of men had dementia in 2019.