Black Box Warnings Not Needed for Compassionate Care

By Mike Connors
CANHR Advocate

Two recent articles help dispel the myth that nursing homes need to use antipsyhchotic drugs to control the behaviors of residents with dementia.

On December 4, 2010, the Minneapolis Star Tribune reported that Ecumen, a small nursing home chain, started a project called “Awakenings” throughout its 15 nursing homes. Instead of drugging residents into a stupor, the chain is phasing out antipsychotic drugs and replacing them with more personal attention, better pain control, exercise, massage, games and other techniques.

One Ecumen nursing home has already eliminated antipsychotic drugs and cut use of antidepressants in half. According to the nurse who manages the project: “The chaos level is down, but the noise is up – the noise of people laughing, talking, much more engaged with life. It’s amazing.”

The Boston Globe reported a similar story on November 18, 2010, describing a Vermont nursing home that eliminated use of antipsychotic drugs after its staff participated in an intensive education program directed by Dr. Susan Wehry, a geriatric psychiatrist. Dr. Wehry taught alternative approaches – such as music and massage – to all staffers, from housekeepers to medical directors.

The results were dramatic. One nursing home that had been using antipsychotics to drug a third of its residents was able to eliminate their use. Dr. Wehry reports that the residents are “much improved in terms of staff-resident interactions and level of alertness… and they looked happier.”

Of course, it is no revelation that elders with dementia usually don’t need to be subdued by antipsychotic drugs if they receive individualized care delivered by skilled, compassionate caregivers. Nonetheless, these nursing homes and their staffs deserve congratulations for their great results and their leadership in showing a better way.

Not only is compassionate care more effective than drugs, it is far less dangerous. As pointed out by Dr. Christine Kovach at the December 8 U.S. Senate Special Committee on Aging forum on dementia care, non-pharmacologic approaches carry no side effects.

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