I have read with a great interest the article by Kales et al.
1
I agree that the Centers for Medicare and Medicaid Services (CMS) program concentrating
on discontinuation of one type of medication in dementia care, which can lead to medication
substitution and which does not include an effort to increase nonpharmacologic strategies
for treatment of behavioral symptoms of dementia, is not going to improve dementia
care. In addition, the CMS program did not take into account that antipsychotics may
be used in treatment of patients with dementia appropriately if the indication was
augmentation of an antidepressant effect.
2
Although I agree with the main object of the study, I have a problem with recommendation
that the describe, investigate, evaluate, and create (DICE) algorithm should be used
for management of behavioral symptoms of dementia.To read this article in full you will need to make a payment
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References
- When less is more, but still not enough: Why focusing on limiting antipsychotics in people with dementia is the wrong policy imperative.J Am Med Dir Assoc. 2019; 20: 1074-1079
- Antipsychotics do not have to be used “off label” in dementia.J Am Med Dir Assoc. 2012; 13: 495-496
- A conceptual framework for rejection of care behaviors: Review of literature and analysis of role of dementia severity.J Am Med Dir Assoc. 2012; 13: 11-23
- The use and utility of specific nonpharmacological interventions for behavioral symptoms in dementia: An exploratory study.Am J Geriatr Psychiatry. 2015; 23: 160-170
- Bathing the Alzheimer's patient in long term care. Results and recommendations from three studies.Am J Alzheim Dis. 1995; 10: 3-11
- The End-of-Life Namaste Program for People with Dementia.2nd ed. Health Professions Press, Baltimore, London, Sydney2013
- Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment.Int Psychogeriatr. 1996; 8: 497-500
- The difficulty with studying challenging behavior.J Am Med Dir Assoc. 2019; 20: 879-881
Article info
Publication history
Published online: January 17, 2020
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© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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- When Less is More, but Still Not Enough: Why Focusing on Limiting Antipsychotics in People With Dementia Is the Wrong Policy ImperativeJournal of the American Medical Directors AssociationVol. 20Issue 9
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- 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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