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Dementia Patients Stay Calm Without Medication

Innovative strategies help Coler-Goldwater staff keep residents safe while reducing use of antipsychotic drugs

Dr. Ravindra Amin and Joyce Bailey

On a recent autumn afternoon, Miss Joyce Bailey, 82, a tiny woman with braided hair, joyfully hummed along with gospel tunes emanating from the headset on her portable music player. The Coler-Goldwater resident, a dementia patient whose voice retains the lilt of her native country of Jamaica, received visitors in a common area whose walls were painted with a green and purple landscape resembling the tropical island. As she chatted with the chief psychiatrist, Dr. Ravindra Amin, she remained cheerful without the use of any medication.

“I love sacred music. Gospel music,” she said in response to a question about what type of music she prefers. “I went to church every Sunday.”

Her serenity was partly a tribute to the work of Dr. Ravindra Amin, Chief of Psychiatry, who along with staff at Coler-Goldwater Specialty Hospital and Nursing Facility began a program in 2009 to improve safety and the quality of care by reducing the use of unnecessary antipsychotic drugs in managing behavioral and psychological symptoms of dementia, which can include restlessness, aggression, delusions and anxiety. Over half of dementia cases present such symptoms.

Their accomplishments earned them the Grand Prize at the New York City Health and Hospitals Corporation’s Patient Safety Expo 2013.

By training the staff in how to use behavioral interventions and comfort measures such as the “Music and Memory program” enjoyed by Miss Bailey, in which personal music devices are made available to patients on a 24/7 basis; and by educating leadership and staff with the most up-to-date evidence-based knowledge about dementia, Dr. Amin and members of the Coler-Goldwater staff were able to steadily and significantly decrease the use of antipsychotic medications.

Use of antipsychotic drugs in the 1300-resident facility’s 500 dementia patients fell to 13% in June 2013 from 38% in January 2011. That is well below the national and New York State averages of 23% and 20.5% respectively.

There are no U.S. Food and Drug Administration-approved medications to control physical aggression or other resistive behaviors in dementia patients, Dr. Amin says. Their use is nonetheless common in nursing home settings, “but their benefits are very modest and come with a slew of side effects,” he said. They include including drowsiness, risk of falls and increased risk of stroke and infections.

In recent years, the federal government has issued a “black box warning” of against the use of antipsychotic medications in elderly dementia patients, citing serious potential adverse side effects; as well as a 2005 public health advisory about deaths involving antipsychotics in elderly patients.

The Coler-Goldwater project aimed at improving the safety and quality of dementia care by establishing a best practice of behavior management, which included better educating and training staff about dementia and its symptoms, and improving cooperation among the departments, including psychiatry and the pharmacy department.

“We have not seen any increase in dangerous outcomes as a result of decreasing use of unnecessary medication,” he said.

Robert K. Hughes, executive director of Coler-Goldwater said, “we like to think of ourselves as a leader in this national movement.”

The project also achieved “moderate” financial savings for the facility and improved the quality of life for patients, as well as staff morale, he said.

“It is a more intimate way of providing care,” Mr. Hughes said.


November 2013

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