Appropriate Use of Antipsychotic Medications

Antipsychotic medications are used extensively in nursing homes. When used for approved disease states - such as schizophrenia, Huntington's disease and Tourette's syndrome - their clinical benefits are widely accepted. In people with a predetermined or long-standing history of mental illness, the chronic use of an antipsychotic medication also may be deemed necessary to stabilize and improve functionality. Sometimes antipsychotic medications are prescribed for off-label use in Alzheimer's disease and other dementia-related illnesses where the effectiveness of the treatment can show mixed results. The off-label use of antipsychotic medications for dementia-related illnesses is unsupported in the literature.

In elderly residents who have dementia, antipsychotics are only appropriate in a small number of instances. Yet, despite the Food and Drug Administration's warnings of increased mortality, the use of antipsychotics as a chemical restraint in nursing home residents who have dementia still persists. Significant morbidity - including higher blood sugar and cholesterol levels, weight gain, increased risk of falls, and decreased cognition - also are associated with the use of antipsychotics. These complications can lead to or cause a worsening of other primary diagnoses known to affect older adults.

HHS Antipsychotic Reduction Initiatives

HHS has several initiatives to help Texas nursing homes reduce the unnecessary use of antipsychotics among residents.

Music & Memory

Some Texas nursing homes have begun using individualized music playlists with patients who have Alzheimer's and other memory disorders to try to reduce the use of antipsychotic medication.

The HHS Music & Memory program began in 2015 with 32 nursing homes. The goal is to help residents reconnect with the world through specific, music-triggered memories. Family members and nursing home staff will create personal playlists for use on digital music players, such as iPods.

Visit the Music & Memory webpage to learn how your facility can introduce this program to your facility.

One A Month Campaign For Reducing Antipsychotic Use

If your facility serves many residents with Alzheimer's disease or dementia, the thought of how to transition them from the medication may seem daunting.

Then why not try this approach: One a Month.

HHS, the Texas Health Care Association, Leading Age Texas and TMF Health Quality Institute have launched the "One a Month" campaign to encourage facilities to commit to transitioning at least one resident a month off antipsychotic medications. The campaign builds on the strides Texas nursing homes already are making in this area.

If successful, that would mean about 1,200 people a month — or nearly 14,000 a year — would be free of those medications and their undesirable side effects.

Toolkit

This toolkit includes resources that will help facilities improve the lives of residents by appropriately reducing the use of antipsychotic medications through proven, non-pharmacological alternatives.

T.R.A.I.N.: Texas Reducing Antipsychotics in Nursing Homes

If you were not able to attend one of the T.R.A.I.N. conferences, the information is still available. HHS Education Services has developed a Joint Training Opportunity, Reducing the Unnecessary Use of Antipsychotics in Nursing Homes, based on the content from the T.R.A.I.N. conferences.

Visit the HHS Provider Joint Training page for more information, and to view the training calendar.

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