Getting older in America has become a frightening prospect for anyone whose body may outlive their mind.
That was a key message last weekend during a lecture at the American College of Physicians Internal Medicine Conference.
In her talk, “Fragile to Agile,” Dr. Melissa L.P. Mattison discussed the impact of delirium in older adults and why antipsychotic medications often prescribed for it aren’t effective. Their sedating effects often pose a safety problem in memory care facilities when unsupervised residents attempt to wander, already unstable on their feet even prior to being doped up.
After reviewing several meta-analyses, Mattison said antipsychotics have no effect on prevention of delirium, duration, severity, duration of ICU care or mortality.
Another study showed 65 percent of patients started on antipsychotics during a hospital visit are still on them the next time they end up there. Almost one-third of all elderly patients given antipsychotics in the hospital will be dead in one year, Mattison said.
Although facilities will push a loved one to medicate their parent to make them “behave,” long-term use of antipsychotics in elderly patients with dementia is not recommended by the U.S. Food and Drug Administration (FDA). It is known to decrease lifespan and not show any effect on lessening the dementia symptoms, Mattison said.
When antipsychotics must be used, only prescribe tiny doses, Mattison said.
Are ‘False Bed Alarms’ Just Causing Ringing in Nurses’ Ears?
Mattison addressed another hot-button issue in elder care: “False Bed Alarms.”
According to Mattison, using bed alarms in elder care facilities is a common strategy, yet one that shows no big benefit.
What’s more, this creates “alarm fatigue” for the staff. Mattison quotes the AHRQ: “There is an overreliance on bed alarms as a fall prevention strategy.”
People whose loved ones are losing their life savings in nursing facilities will tell you they don’t much care whether nurses become aggravated by the alarms. They want their loved one picked up off the floor the minute they fall. For example, bed alarms don’t work if they’ve been unplugged by housekeeping, a hospice worker, or even another elderly resident who may wander into another patient’s room.
Mattison advocated for keeping the elderly out of the hospital whenever possible. She said hospitalization leads to poor sleep, being poked by needles, lack of mobility and abrupt care transitions.
She encouraged her colleagues to implement the Clinical Frailty Scale into their practices. Physicians use this method to determine a best course of action for keeping an acutely ill senior out of the hospital and successfully transitioned back to home for as long as possible.