Abstract
Objectives
An educational program to enhance communication in nursing home dementia care increased
person-centered communication by staff and resulted in reduced resident behavioral
symptoms measured as resistiveness to care. The purpose of this analysis was to evaluate
effects on resident antipsychotic medication use in participating nursing homes. The
National Partnership to Improve Dementia Care set a goal of reducing antipsychotic
medications in nursing homes by 15% during the study period.
Design
A post hoc analysis of Nursing Home Compare data was used to evaluate change in antipsychotic
medication rates in nursing homes receiving the communication education versus the
corresponding statewide average change.
Setting and Participants
Eleven nursing homes participated in a cluster-randomized controlled trial from 2011
to 2013 in one Midwestern state.
Measures
Antipsychotic medication rates were abstracted from Nursing Home Compare data sets.
Antipsychotic medication rates were compared for each participating nursing home for
the 2 quarters before and the 2 quarters after the communication intervention. To
control for other factors supporting reduction in antipsychotic use, changes in the
participating nursing homes were compared to the state average change for the corresponding
quarters using a 1-sample t test.
Results
Antipsychotic medication use decreased on average by 4.88 percentage points (22.9%)
in participating nursing homes compared to the state average decrease of 0.68 percentage
points (2.7%) during the same period (P = .06).
Conclusions
A clinically meaningful reduction in antipsychotic medication usage occurred in the
nursing homes that received communication education. Measurable changes in communication
and behavioral symptoms were reflected in reductions in antipsychotic medication usage.
Improving staff communication has the potential to reduce inappropriate antipsychotic
medication use in long-term care.
Keywords
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References
- Rationales that providers and family members cited for the use of antipsychotic medications in nursing home residents with dementia.J Am Geriatr Soc. 2015; 63: 302-308
- Antipsychotic use in dementia: A systematic review of benefits and risks from meta-analyses.Ther Adv Chronic Dis. 2016; 7: 229-245
- Report on the CMS National Partnership to Improve Dementia Care in Nursing Homes: Q4 2011–Q1 2014.2014 (Available at:) (Accessed June 7, 2018)
- The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia.Am J Psychiatry. 2016; 173: 543-546
- Choosing wisely: Ten things clinicians and patients should question.2015 (Available at:) (Accessed June 7, 2018)
- (Medicare atypical antipsychotic drug claims for elderly nursing home residents. Available at:)2011 (Accessed June 7, 2018)
- Efforts to reduce antipsychotic use in dementia care are starting to bear fruit, but a lot of work remains to be done.J Am Med Dir Assoc. 2017; 18: 204-206
- “They Want Docile:” How Nursing Homes in the United States Overmedicate People with Dementia.2018 (Available at:) (Accessed June 8, 2018)
- Assessment and management of behavioral and psychological symptoms of dementia.BMJ: British Medical Journal. 2015; 350: h369
- What are the barriers to performing nonpharmacological interventions for behavioral symptoms in the nursing home?.J Am Med Dir Assoc. 2012; 13: 400-405
- The health professional experience of using antipsychotic medication for dementia in care homes: A study using grounded theory and focussing on inappropriate prescribing.J Psychiatr Ment Health Nurs. 2018; 25: 307-318
- Influences on decision-making regarding antipsychotic prescribing in nursing home residents with dementia: A systematic review and synthesis of qualitative evidence.J Am Med Dir Assoc. 2017; 18: 897.e1-897.e12
- Knowledge of and perceived need for evidence-based education about antipsychotic medications among nursing home leadership and staff.J Am Med Dir Assoc. 2013; 14: 895-900
- Timed-event sequential analysis of agitation in nursing home residents during personal care interactions with nursing assistants.J Gerontol B Psychol Sci Soc Sci. 2002; 57: P461-P468
- Elderspeak communication: Impact on dementia care.Am J Alzheimers Dis Other Demen. 2009; 24: 11-20
- Communication predicaments of aging: Patronizing behavior toward older adults.J Lang Soc Psychol. 1995; 14: 144-166
- Understanding elderspeak from the perspective of certified nursing assistants.J Gerontol Nurs. 2015; 41: 42-49
- Is elderspeak appropriate? A survey of certified nursing assistants.J Gerontol Nurs. 2014; 40: 44-52
- Co-occurrence and predictors of three commonly occurring behavioral symptoms in dementia: Agitation, aggression, and rejection of care.Am J Geriatr Psychiatry. 2017; 25: 459-468
- Development and testing of the Resistiveness to Care Scale.Res Nurs Health. 1999; 22: 27-38
- Nursing aide reports of combative behavior by residents with dementia: Results from a detailed prospective incident diary.J Am Med Dir Assoc. 2012; 13: 220-227
- Resistiveness to care during assistance with activities of daily living in non-institutionalized persons with dementia: Associations with informal caregivers' stress and well-being.Aging Mental Health. 2016; 20: 888-898
- A communication intervention to reduce resistiveness in dementia Care: A cluster randomized controlled trial.Gerontologist. 2017; 57: 707-718
- Five-star quality rating system downloads.(Available at:)2016https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/fsqrs.htmlDate accessed: June 15, 2016
Centers for Medicare and Medicaid Services. About Nursing Home Compare Data; n.d. Available at: https://www.medicare.gov/nursinghomecompare/Data/About.html#dataSource. Accessed June 7, 2018.
- MDS 3.0 Quality Measures User’s Manual.2012 (Available at:) (Accessed June 7, 2018)
- Nursing home compare five-star quality rating system: Year five report [public version].2014 (Available at:) (Accessed September 20, 2018)
- Nursing facilities, staffing, residents and facility deficiencies, 2009 through 2016: Supplemental tables.2018 (Available at:) (Accessed September 20, 2018)
- Quality of care in for-profit and not-for-profit nursing homes: Systematic review and meta-analysis.Br Med J. 2009; 339
- Observational evidence of for-profit delivery and inferior nursing home care: When is there enough evidence for policy change?.PLoS Med. 2016; 13: 1-12
Article info
Footnotes
This research was supported by the National Institute of Nursing Research of the National Institutes of Health under award number R01NR011455-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
The authors declare no conflicts of interest.
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