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Digiceuticals in Aging: Reducing Psychotropic Medication Usage in the Elder Population

3/30/2018 1:22:37 PM

When we talk about Person Centered Care and what can be done to improve quality of life in community and residential care settings, the overuse of psychotropic medication is a large concern.

 

More than half of older adults who are admitted to nursing homes receive psychotropic medications within 2 weeks of their admission.[1] The safety of these drugs with older adults is questionable, as psychotropic medications can induce or worsen hypotension and can put elderly clients at greater risk for falls and fractures, particularly when given in combination with other medications and in the presence of other comorbid medical conditions.[2] Additionally, one study noted that only 45% of nursing homes employ nurses who have had psychiatric training. [3]

 

Let’s think about this for a moment. Older adults are admitted to care centers for their safety and well- being—but the medications they are given once they are there can endanger them further. Why? Well, no pharmacological treatment for the majority of DSM-5 diagnoses and no FDA indicated medications treat the behaviors of cognitively impaired adults. [4] To compound that issue, comorbidity makes the use of these medications dangerous. When you mix medications, the interactions can be deadly for someone frail with multiple conditions that may already make them unsteady and disoriented.

 

Psychotropic medications, or mood-altering drugs, have many purposes. Antipsychotic medications are usually prescribed for symptoms such as delusions and hallucinations. However, psychotropics are frequently given to older adults with cognitive impairment to manage disruptive behaviors.[5] These behaviors are often what land a person in a long term care facility in the first place.  If a person has difficulty managing activities of daily living (getting dressed, toileting, bathing, etc.) this can largely be managed in the home with homecare and aides. If a person has significant cognitive impairment, such as dementia, Alzheimer’s disease, or a traumatic brain injury, their day to day behavior will often change in such a way that it becomes impossible for them to live in their own home .Varied behaviors like chronic hair pulling, yelling, smoking (and then forgetting the cigarette), wandering, sexually inappropriate behavior, resisting care such as bathing or dressing, hoarding, cattiness, and stealing create an endless variety of exhausting and potentially dangerous concerns. 

 

Moving a cognitively impaired adult to long term care improves their safety, but their behaviors are just as difficult to manage in a long term care setting as it is at home.  Nursing staff must focus first on providing care for basic needs and medical concerns. Coping with problem behaviors becomes frustrating to other residents and staff. It is vital to the point of becoming a first priority when the behaviors occur—but managing the behaviors is also time consuming and often fruitless. Any caregiver can tell you that simple redirection doesn’t work. Traditional counseling and therapy cannot work either, as a person with cognitive impairment does not have the same ability for self-reflection and self-awareness that an average person does. So the behaviors continue. This cycle in turn affects overall quality of life, and the quality of care for every resident—not just the one exhibiting troubling behaviors. Even in the very best centers, this is the single most difficult barrier to providing superior, cost-effective, person centered care.

 

Digital therapeutics and Digiceuticals are new options that may bring some help to caregivers and cognitively affected persons alike. What these products do is either augment or completely replace commonly prescribed medications.[6] They are low risk changes with big benefits.  Unlike typical health and wellness apps, digital therapeutics help patients manage a condition and are an alternative treatment to drugs that use sensory stimuli (usually from a mobile device) to manage chronic conditions that are poorly addressed by the healthcare system.[7]

 

The potential for digiceuticals and digital therapeutics is vast. In aging, digiceuticals specifically developed for cognitive impairment are low cost investments that decrease unwanted, potentially harmful behaviors without adding excess strain on nursing staff.  An intuitive, easy- to- use program that could be run from a cell phone, tablet, or kiosk can guide staff in adding  structure and therapeutic elements needed to quickly and deeply connect with a person who has lost their connection with themselves and the world. Connections are what life is about. If person centered care is to become truly holistic, we need to do our very best to not just connect on a human level with every elder in every way we can, but also to foster a workable relationship between structure, free will, and human purpose.

 

LifeBio is a reminiscence-based digiceutical that will make a difference in the lives of the older adults that you care for each and every day.  For more information on LifeBio, please visit our website, www.lifebio.com.

 

[1] Lindsey P. Psychotropic Medication Use Among Older Adults: What All Nurses Need to Know. The US National Library of Medicine National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128509. Accessed March 16, 2018.

[2]  Lindsey P. Psychotropic Medication Use Among Older Adults: What All Nurses Need to Know. The US National Library of Medicine National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128509. Accessed March 16, 2018.

[3]  Lindsey P. Psychotropic Medication Use Among Older Adults: What All Nurses Need to Know. The US National Library of Medicine National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128509. Accessed March 16, 2018.

[4] LaFerney M.  Behavior Management in Nursing Homes.  Reflections on Nursing Leadership.Org. https://www.reflectionsonnursingleadership.org/commentary/more-commentary/Vol42-1-behavior-management-in-nursing-homes. Accessed March 16, 2018.

[5] Lindsey P. Psychotropic Medication Use Among Older Adults: What All Nurses Need to Know. The US National Library of Medicine National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128509. Accessed March 16, 2018.

[6] Farr C. Can “Digital Therapeutics” Be as Good as Drugs? MIT Technology Review. https://www.technologyreview.com/s/604053/can-digital-therapeutics-be-as-good-as-drugs/. Accessed March 16, 2018.

[7] Joyce M, LeClerc O, Westhues K, Xue H. Digital Therapeutics: Preparing for Takeoff. https://www.mckinsey.com/industries/pharmaceuticals-and-medical-products/our-insights/digital-therapeutics-preparing-for-takeoff#0. Accessed March 16, 2018. 

 

Amber Dennis is a staff writer and personal biographer for LifeBio, where she helps record personal histories.  Before working for LifeBio, Amber worked for a number of years in customer service, and also worked in nursing homes and home care as an STNA.  She holds a BA in History from Otterbein University.

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