For the over 5 million Americans suffering from Alzheimer’s disease, a large percentage must also deal with the effects of over-prescription of antipsychotic drugs. One Minnesota care organization has effectively demonstrated an alternative approach that both reduces prescription drug use and improves patient behaviors.
Ecumen, a Minnesota-based senior care provider, has used behavioral and other alternative techniques to reduce antipsychotic drug use by a whopping 98 percent. Its Awakenings program has helped more than 1,200 patients in its 16 nursing homes across the state. According to a recent article in the Washington Post, Medicaid and Medicare spending has been reduced by up to $350,000 per month. Affected patients have reduced behavioral symptoms and improved mental alertness as well.
Geriatric professionals have long argued that patients can become disengaged and inactive due to the overuse of antipsychotic medications, which are given to calm problematic behaviors, such as wandering and aggression. Although federal law mandates that such drugs should only be used as a last-resort safety precaution, an estimated one-quarter of all nursing homes residents may receive antipsychotic drugs, according to a New York Times blog. An additional untold number of dementia patients residing in other settings also receive these medications.
Ecumen’s Awakenings approach focuses on behavioral interventions and more thorough patient assessment. As described on its website, the Awakenings model, has a four-part focus:
Health Discovery – Includes a close review of relevant medical history, including why any medications were prescribed.
Personal Discovery – Develops a “biographical picture” of the patient; e.g., learning individual’s personal interests, key life events, etc.
Care Strategy – Develops an individualized plan of care, in coordination with physician, care team and family.
Implementation, Observation, Assessment – Integrates medication monitoring and tapering of psychotropic medications with non-pharmaceutical interventions. Examples range from art therapy to cooking. Patient reactions are tracked closely to determine trends.
One key to the Awakenings approach is the use of interventions that are associated with at least one of the five senses. Something as simple as the introduction of aromatherapy can have a calming effect. The interventions are also tied to the individual’s unique history and needs. For example, knowing that a patient was once an avid knitter can create a relevant subject for reminiscence. Or being aware that an individual wants to be more mobile may help staff reduce inappropriate behaviors and facilitate mobility with assistive technology.
A major key to the success of the Awakenings program is its focus upon identifying and responding to triggers for inappropriate behavior, rather than masking them through medication. The approach is also customized to the individual. And it’s not all high technology – in the words of one Ecumen employee, “The hands-on, caring part is the most important. Sometimes, people just want a hug. You sit and hold their hand.”
As Ecumen explains, for every unwanted behavior, there is some unmet need. For example, if the patient is wandering, he or she is looking for something – a bathroom, a job, a family member. By truly knowing a patients’ history, interests, and needs, staff can better respond to that particular moment. In doing so, they humanize the patient, responding to the individual and not just the diagnosis.
The lessons of the Awakenings project have value for caregivers and families of any individual with dementia, regardless of treatment or residential setting. We can all benefit from taking a more individualized approach to care that focuses on needs rather than “bad” behaviors, and that recognizes the humanity and dignity of the individual.