We appreciate the attention Drs Kale, Gitlin, and Lyketsos bring to CMS's singular
focus on antipsychotic use in those long-term care (LTC) residents with dementia and
behavior disturbance. As the authors point out, these universal behaviors are themselves
associated with poor health outcomes including mortality, injury to peers and staff,
and other undesirable outcomes. We agree with their premise: the focus on this 1 class
of medication without assessing the resident and the entire situation is both misguided
and leads to the use of less effective, more risky, and less evidence-based interventions.
The focus on antipsychotic rates distracts from the imperative to implement comprehensive
person-centered care for this group of disabled older adults.
1
All behavior contains communication. For those with dementia, behavior may be the
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References
- Neurocognitive Behavioral Disorders: An Interdisciplinary Approach to Patient-Centered Care.Springer, Cham, Switzerland2019
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Article info
Publication history
Published online: February 26, 2020
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Response to Letters to the Editor the Imperative for Person-Centered Care: Focus on Assessing and Working With LTC Residents Rather Than Percent of People on Medication Without Data on Appropriate Use and Problems With DICE and BPSDJournal of the American Medical Directors AssociationVol. 21Issue 4
- PreviewThe response letter by Nash et al to our recent article1 raises the concern that the palliative care “lens” was missing from the patient vignette. We would note that the case described a patient who has moderate dementia and thus, we would not consider this person to have “advanced” illness. We agree that more attention is needed to understand when the person living with dementia is approaching end of life, as this can be difficult to ascertain in the course of an illness that can last up to a decade.
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