Since 1999 Medicare and the State have been monitoring nursing homes for appropriateness of drugs because the evidence is clear: too many drugs, particularly those on Beer’s List, increase the risk that seniors will have more problems, including falls, broken bones, confusion, constipation, and in general just not enjoying life as much!!
Beer’s List includes over 53 drugs and drug categories, divided into, 1) drugs to avoid in all older adults, 2) those to avoid when specific diseases are present (because the drug will worsen the disease), and 3) those which may be used but only with great caution. [google it for all the details]
When many of those drugs are stopped, seniors feel better; and a study from 2010 found that cutting the number drugs by half also did not cause any problems.
That’s why nursing homes are required to attempt to reduce all psychotropic drugs (those affecting emotions): anti-anxiety, anti-depressants, sleep (hypnotics), and anti-psychotics (for hallucinations or delusions). This is called GDR – Gradual Dose Reduction—and must be done regularly for these medications.
The majority of NH residents have dementia and most will develop, at some point, agitated behavior. The doctor’s response is unfortunately to often prescribe an anti-psychotic and/or anti-anxiety drug. In Europe, 33% of NH residents take anti-psychotics while in this area it ranges from 11% to 32%.
It’s important that the facility first look for what might cause agitation: pain is common (chronic arthritis); wet pants; caregiver incompatibility; loud noise. By treating the ‘root cause’ of the problem when possible, and trying non-pharmaceutical options first, such as aromatherapy (lavender has been shown to work!), we can often avoid these more dangerous drugs.