Friday, February 18, 2011

PowerUp Friday: Culture change “awakenings” «

By Dr. Al Power in the Changing Aging blog

Bill asked me to respond to a profile in The New York Times New Old Age blog Tuesday on Sunrise Nursing Home in Two Harbors, Minn, highlighting their work in reducing psychotropic medications in people living with dementia. The resultant “awakenings” of the people coming off the medications has convinced Ecumen, the parent organization, to bring the approach to 15 other nursing homes in the state.

At Sunrise, all 10 people who were taking antipsychotics successfully stopped the medication. This validates several studies (heretofore largely ignored by the medical press), which have shown that, with targeted interventions, the vast majority of people in nursing homes can have their anrtipsychotic drugs removed, with no objective evidence of worsening behavioral distress.

The key for Sunrise was to enlist the entire staff of the home in understanding and learning how to connect with and respond to the needs of the elders–a sort of cross-training in dementia. They also added two staff for this home of 60 elders, costing about $75,000 in annual salaries. But the price of the 10 antipsychotic drugs alone is at least half that annually, not to mention the decreased distress and increased well-being that resulted. A small price to pay indeed.

Kudos to Sunrise for their courageous leap forward, and for getting the word out through the New Old Age blog. It is critical that we educate both the public and long term care providers that there is a clear alternative to “being a zombie in a nursing home,” as Laurel Baxter, the Awakenings project manager, puts it. I have now corresponded with four Times reporters in the past year, one in a personal meeting, but have yet to see this issue seriously addressed in the print version.

In the article, Dr. Mark Lachs of Weill Cornell Medical College made the important observation that these drugs “get perpetualized, like insulin”. I often tell audiences that these drugs are highly addictive–not to the person with dementia, but to the families and care staff.

The article continues to perpetuate some ideas, however, which I believe to be patently false. One is that the medications still have an important role in soothing some people’s distress. While the drugs may be occasionally needed in emergency situations, they will never correct unmet needs, and should never be seen as helping a person attain well-being. The “soothing” is primarily sedation–it is almost never an answer to the real problem.

The other is the notion that these “behaviors” are an inevitable result of brain disease. I believe they are the result of a mismatch between the needs of a changing individual and an environment that is inadequate to meet those needs. As I’ve said before, it’s like expecting a paraplegic to walk, and then sedating him when he gets frustrated that we won’t give him help for his disability.

Last week, Dr. Richard Taylor came to town and reminded us that “I am not dying of a fatal disease; I am living with a chronic disability.” However you choose to classify dementia, this view creates a whole new paradigm for helping each person achieve her or his highest practicable level of well-being. That will never be found in a bottle.

Dr. Al Power is author of Dementia Beyond Drugs and a weekly contributor to

PowerUp Friday: Culture change “awakenings” «
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