I have read with a great interest the article by Kales et al.
1I 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.
- Kales H.C.
- Gitlin L.N.
- Lyketsos C.G.
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
2Although 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.
- Volicer L.
Antipsychotics do not have to be used “off label” in dementia.
J Am Med Dir Assoc. 2012; 13: 495-496
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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 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
Published online: January 17, 2020
© 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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