Recent studies indicate that limiting the use of certain medications can improve a senior's life. One study, conducted by researchers at Indiana University, finds that the prolonged use of anticholinergics may cause physical changes within the brain that could lead to dementia. Furthermore, The Canadian Foundation for Healthcare Improvement (CFHI) released information related to a program it started in 2014: This study examined how the discontinuation of antipsychotic medications affected the seniors who were taking them to treat dementia. The results indicate that seniors’ lives may improve when antipsychotic medications (that are being used to treat dementia) are discontinued.
Taking Anticholinergics May Increase a Senior’s Risk of Developing Dementia
Shannon Risacher, who is an assistant professor of radiology and imaging at the Indiana University (IU) School of Medicine, states that the concerns related to taking anticholinergics involve an increased risk of dementia, especially for individuals who have a genetic predisposition for developing the condition.
Anticholinergics Disrupt the Nervous System
Anticholinergics stop acetylcholine from working properly. Acetylcholine is a chemical in the nervous system that, among other things, is responsible for easing respiratory, gastrointestinal or urinary systems.
The IU Study: Association Between Anticholinergic Medication Use in Cognitively Normal Older Adults
The researchers at Indiana University studied the brain scans and cognitive test results of 451 adults with an average age of 73 years, 60 of whom had been taking anticholinergic medications for at least one month. The researchers observed distinct variations among the participants taking anticholinergics: These participants had reduced brain volume and a thickening in areas of the brain linked to cognitive function. Furthermore, researchers noted decreased levels of glucose processing within the brain, as well as lower scores on the memory tests that were utilized during the study.
Seniors Taking These Medications Should Know the Potential Risks
Sandra Black is a senior scientist at the Sunnybrook Research Institute, she states that seniors need to be aware of the potential risks associated with taking these medications. In addition, Risacher says that seniors who think they could be at risk of developing dementia or notice that their memory is changing may want to consider seeing their physician, especially if they are taking anticholinergic medications. Black states that there are alternatives to these medications; therefore, these increased risks are avoidable.
The Canadian Foundation for Healthcare Improvement's Program
According to Kay Phillips, who is the senior director for The Canadian Foundation for Healthcare Improvement (CFHI), approximately 62 percent of the seniors residing in long-term care facilities have dementia. Antipsychotic medications may be prescribed as a means to control aggressive behavior that is brought on by dementia: Nearly 30 percent of Canadian seniors residing in long-term care facilities take antipsychotic medications despite the fact that they do not have psychosis. A report from the CFHI suggests that discontinuing these medications for an alternative treatment may be more beneficial to these seniors.
The CFHI’s pan-Canadian Reducing Antipsychotic Medication in Long Term Care Program
Phillips states that individuals with dementia often display resistance to care, confusion, disruptive or aggressive behaviors: For these reasons, many seniors who are not actually suffering from psychosis are given antipsychotic medications. The goal of the pan-Canadian Reducing Antipsychotic Medication in Long Term Care program was to encourage long-term care facilities and nursing homes to discontinue the use of unnecessary antipsychotic medications to experiment with alternative therapies.
Choosing the Study Participants
The CFHI teamed up with 56 long-term care facilities located throughout eight Canadian territories and provinces to determine which senior residents could be tapered off of their antipsychotic medications. Once eligible residents were identified, physicians, facility nurses and support personnel met with the residents' families to identify the reasons their loved ones’ were displaying challenging behaviors.
Once this initial phase was complete, the physicians and facility staff began to implement non-pharmacological therapies designed to better manage and prevent challenging behaviors.
Phillips states that in an attempt to re-introduce the simpler aspects of life, they implemented new recreational therapies for the dementia patients who participated in their study. Researchers took into consideration each resident’s social, cultural and intellectual needs when determining which activities would serve him or her the best.
The alternative therapies included:
- Pet therapy
- Music therapy
As these new therapies were implemented, residents’ antipsychotic medications were either reduced or discontinued altogether.
More than half of the study participants had their antipsychotic prescriptions changed:
- 36 percent discontinued their medication
- 18 percent had their dosages reduced
Rather than seeing a rise in aggressive behavior, a substantial decrease in such behaviors was noted:
- Incidents related to resisting care decreased by 22 percent
- Verbally abusive behavior decreased by more than 33 percent
- Falls decreased by 20 percent
- Socially inappropriate behavior decreased by 26 percent
- Physically abusive behavior decreased by nearly 30 percent
Furthermore, Phillips states that numerous families voiced their satisfaction with the study results stating that they ‘got their loved ones back.’
The Canadian Foundation for Healthcare Improvement states that if all the long-term care facilities in Canada gave their residents more social and psychological supports, within just 5 years:
- 25 million antipsychotic prescriptions can be avoided
- There would be 19,000 fewer visits to the emergency room
- 91,000 falls would never happen
- There would be 7,000 fewer hospitalizations
- 35,000 Long-term care residents would be able to reduce or discontinue their antipsychotics each year
The staff members at long-term care facilities need to support quality of care to improve the quality of life their residents' experience.
How to Achieve This Goal
In order to reduce the number of seniors in long-term facilities who are needlessly taking antipsychotic medications, steps must be taken to change the practice of over-medicating seniors with dementia, while implementing alternative programs. Healthcare providers need to work with family members, conduct regular medication reviews, as well as take extensive and accurate patient histories.