Medication Reduction in Persons with Dementia Nursing Staff Education

The Problem Too many residents are taking too many medications! Are all of these medications necessary? What are the risks associated with unnecessary medication dosing?

Why so many drugs? multiple medical co-morbidities often multiple drugs for single diagnosis cognitive and behavioral issues weight loss infections pharma advertising to public family pressure

Why so many drugs? most residents enter facility with a long list of medications and they are written as part of admitting orders and then, they simply are continued drug holidays, withdrawal (OBRA) easily circumvented nursing requests for something for: fever, cough, infection, weight loss, behavioral issues

Symptom control skin lungs pain behaviors the symptom of abnormal labs…

Caregiver burden and well- being well-being directly affected by perceived social support burden self-esteem hours of informal care Chappell, Reid. Burden and well-being among caregivers: examining the distinction. Dec 2002 Gerontologist:42(6)

Caregiver burden and well- being burden directly affected by behavioral problems break frequency self-esteem hours of informal care Chappell, Reid. Burden and well-being among caregivers: examining the distinction. Dec 2002 Gerontologist:42(6)

Risks of excessive medications administration issues missed doses more meds to pass more documentation higher cost (to family/resident and to facility)

Risks of excessive medications side effects drug-drug interaction somnolence, lethargy, decreased cognition less active, increasing debilitation, falls increase in ADL support needs weight loss, contractures sentinel events: dehydration, fecal impaction, pressure sores resistance to care

Risks of having ADR related to number of medications Number of medsRisk of ADR 26% 550% 8100% Shaughnessay AF. Common drug reactions in the elderly. Emerg Med. 1992;24:21-32., as quoted in Dayer-Berenson L. Polypharmacy in the Elderly. Nursing Spectrum website. Available at Accessed February 24,

Adverse Drug Reactions rate of ADR: 67% 14% of ADRs required hospitalization Cooper J. Adverse Drug Reaction-Related Hospitalizations of Nursing Facility Patients. May 1999, Southern Medical Journal: 92(6),

Adverse Drug Reactions 16% of residents in snf hospitalized for ADR (additional 50% of residents had ADR, but did not require hospitalization) hospitalization most commonly due to NSAID (GI bleed) psychotropic-related fall with fracture digoxin toxicity insulin hypoglycemia account for 80% of ADRs Cooper J. Adverse Drug Reaction-Related Hospitalizations of Nursing Facility Patients. May 1999, Southern Medical Journal: 92(6),

Adverse Drug Reactions 5 residents (of 52) had recurrence of hospitalization for the same problem number of meds (adjusted for number of problems) ADR hospitalizednon-ADR 7.9 ± ± 1.3 Cooper J. Adverse Drug Reaction-Related Hospitalizations of Nursing Facility Patients. May 1999, Southern Medical Journal: 92(6),

Adverse Drug Reactions psychotropics implicated in fall-related fractures Cooper J. Adverse Drug Reaction-Related Hospitalizations of Nursing Facility Patients. May 1999, Southern Medical Journal: 92(6),

Nursing role in reducing medications learn behavior management skills resistance to care negative interpersonal interaction wandering calling out use non-pharmacologic management be role model for caregivers

Nursing role in reducing medications maintain excellent assessment skills accurate reporting to physician avoid knee-jerk response to issues to get something from the doctor work with physician on medication withdrawal and reduction monitoring for flare of symptoms work with pharmacist in identifying possibilities for medication reduction

Nursing role in reducing medications educate staff residents and families physicians!