The Globe recently explored the overuse of antipsychotic drugs in nursing home patients with dementia. The two-part series — which included a database of facilities nationwide and their frequency of prescribing antipsychotic drugs inappropriately — prompted a flood of calls to the toll-free Alzheimer’s helpline, 800-272-3900. Readers wanted advice on finding the right nursing home for their loved one, which can be the most heart-rending and perhaps toughest decision that many of us will ever have to make.
I asked Susan Rowlett, manager of care consultation at the Alzheimer’s Association’s Massachusetts/New Hampshire Chapter, to provide some important questions to ask. Here are some key ones she recommending asking yourself and the professionals:
1. What is the percentage of residents in Alzheimer’s Special Care Unit that are on mood-altering medications like antipsychotic drugs? If more than 25 percent of residents are using antipsychotic medications, this may indicate that the Unit relies more on medications rather than behavioral techniques to calm aggressive symptoms, according to the Alzheimer’s Association.
The Globe report winnowed this down further to determine the rate of prescribing antipsychotic drugs to those without psychosis or a related condition — which isn’t recommended by the US Food and Drug Administration for safety reasons. The report found that the national median for using antipsychotics in such patients was 16.7 percent, but you also need to ask about the percentage of residents with behavioral problems in the facility since that can correlate with rates of prescribing these medications. “Some nursing homes may work with those who have higher likelihood of psychiatric problems,” pointed out Rowlett, “while others don’t accept any patients with behavioral challenges.”
2. What feeling do you get when visiting the nursing home? Are the nursing assistants smiling when they do their work? “Sit and watch the staff interact with the residents and count the number of times you see a resident hugged or touched affectionately by the staff,” said Rowlett. Does the staff make eye contact with residents? Do they speak slowly, clearly, and respectfully? If you see a lot of residents sitting by themselves, staring into space, that’s not a good sign.
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