Dementia and Healthcare’s Choice

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Blog post by Joe Babaian

Kindness can transform someone’s dark moment with a blaze of light. You’ll never know how much your caring matters. Make a difference for another today.

― Amy Leigh Mercree

Talking about dementia, elder care, and the journey towards the end of life is not easy but it doesn’t have to be ugly. I’m a firm believer in the power of knowledge, collaboration, and hope. Amy Mercree’s quote above really sums it up.

The extended #hcldr community – including YOU – is a treasure of hard and soft healthcare science, information, shared ideals, and the ability to leverage all of this to get things done: move the needle in healthcare from clinical work, research, digital health, medical education, patient support, elder care, and more.

This week on #hcldr I want to touch on a topic that I tried to look away from, but couldn’t. It’s a difficult discussion and I am certain we can share both professional and personal insights to delve deeper. I just read the report “They Want Docile” by Human Rights Watch.  Not an easy read, but a critical one. Telling is the subtitle of the report: How Nursing Homes in the United States Overmedicate People with Dementia. 

The conversation grew and the comments from doctors, caregivers, advocates, social workers, and family members really resonated. Everyone knows about the problem and many have solutions but we don’t have a unified, national solution to a problem that extends beyond just the dangers of over-medication or polypharmacy in the elderly. We need to bring together the brightest voices with solutions and match them with the hardest hit and vulnerable parts of our population – the elderly and especially the elderly at risk with dementia, Alzheimer’s, multiple comorbidities, and other impairments.

A worrying trend is mentioned by Lisa Esposito in “Deprescribing Medications for Older Adults” from U.S. News and World Report:

More than one-third of U.S. adults in their early 60s and beyond take at least five prescription medications, according to a review article in the July 2017 issue of the Journal of Family Practice. The study, led by Dr. Kathryn McGrath, a geriatrician and an assistant professor affiliated with Thomas Jefferson University Hospitals in Philadelphia, gives healthcare providers a roadmap for deprescribing.

This trend is showing no signs of abating and, in fact, the Newcastle University Institute for Aging has found:

The number of older people with four or more chronic diseases is expected to nearly double by 2035.

This type of evidence can’t be dismissed and now is the time for action.

Let’s take a moment to consider this topic and share experiences, solutions, problems that can be solved together, and hope for the future of these at-risk populations. People, plain and simple.

Please join me on Tuesday, February 6th at 8:30pm ET (for your local time click here) for the weekly #hcldr tweetchat where we will be discussing Dementia and Healthcare’s Choice:

  • T1: How have you been faced with dementia or Alzheimer’s and the associated risks with care personally or professionally?

  • T2: What must we do to improve institutionalized elder care (skilled nursing, LTAC, etc.) to counter devastating outcomes such as overmedication and abuse?

  • T3: Share some examples of great outcomes for elder care both in a home-based environment and within a facility.

  • T4: How should healthcare respond to the coming wave of an aging population with multiple comorbidities?

References

“‘They Want Docile’ | How Nursing Homes in the United States Overmedicate People with Dementia.” Avenue, Human Rights Watch | 350 Fifth, 34th Floor | New York, and NY 10118-3299 USA | t 1.212.290.4700.  Human Rights Watch, February 5, 2018. https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia.

“Comorbidity and Polypharmacy in People with Dementia: Insights from a Large, Population-Based Cross-Sectional Analysis of Primary Care Data.” Clague, Fiona, Stewart W. Mercer, Gary McLean, Emma Reynish, and Bruce Guthrie.  Age and Ageing 46, no. 1 (January 19, 2017): 33–39. https://doi.org/10.1093/ageing/afw176.

“Deprescribing Medications for Older Adults.” US News & World Report. Accessed February 6, 2018. https://health.usnews.com/health-care/patient-advice/articles/2018-01-17/deprescribing-medications-for-older-adults.

“Polypharmacy and Potentially Inappropriate Medication Use among Community-Dwelling Elders with Dementia.” Lau, Denys T., Nathaniel D. Mercaldo, Andrew T. Harris, Emily Trittschuh, Joseph Shega, and Sandra Weintraub.  Alzheimer Disease and Associated Disorders 24, no. 1 (2010): 56–63. https://doi.org/10.1097/WAD.0b013e31819d6ec9.

“Mortality Risk Associated with Psychotropic Polypharmacy in Patients with Dementia.” Nørgaaard, A., C. Jensen-Dahm, C. Gasse, T. Wimberley, H. Elsebeth Steno, and W. Gunhild.  Journal of the Neurological Sciences 381 (October 15, 2017): 1028. https://doi.org/10.1016/j.jns.2017.08.2902.

“Psychotropic Polypharmacy in Patients With Dementia: Prevalence and Predictors.” Nørgaard, Ane, Christina Jensen-Dahm, Christiane Gasse, Elsebet Steno Hansen, and Gunhild Waldemar.  Journal of Alzheimer’s Disease 56, no. 2 (January 1, 2017): 707–16. https://doi.org/10.3233/JAD-160828.

“Number of Older People in England with Four or More Diseases Will Double by 2035, Say Researchers — ScienceDaily.” Accessed February 6, 2018. https://www.sciencedaily.com/releases/2018/01/180123101919.htm.

“Older Patients with 4+ Chronic Diseases Expected to Double by 2035.” Cardiovascular Business. Accessed February 6, 2018. http://www.cardiovascularbusiness.com/topics/vascular-endovascular/elderly-patients-4-or-more-chronic-diseases-expected-double-2035.

“The Association between Polypharmacy and Dementia: A Nested Case-Control Study Based on a 12-Year Longitudinal Cohort Database in South Korea.” Park, Hae-Young, Ji-Won Park, Hong Ji Song, Hyun Soon Sohn, and Jin-Won Kwon.  PLoS ONE 12, no. 1 (January 5, 2017). https://doi.org/10.1371/journal.pone.0169463.
Schüssler, Sandra, and Christa Lohrmann. Dementia in Nursing Homes. Springer, 2017.

Photo Credit:  http://www.imgur.com/a/KiYPS

 

 

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