Background and Objectives: To avoid "chemical restraints," policies and guidelines have been implemented to curb the use of medications for behavioral and psychological symptoms of dementia (BPSD). Antipsychotics have been particularly targeted because of their rare severe side effects. Consequently, caregiver directed non-pharmacologic therapies have increased while medication use for BPSD has diminished. Despite such initiatives, however, antipsychotics continue to be prescribed "off-label" for roughly 20% of nursing home patients. How caregivers impact management approaches and prescribing decisions for BPSD, including antipsychotic use, is poorly understood. Aim: assesses experiences and perceptions of family and nursing caregivers regarding factors influencing medication decisions for BPSD. Research Design and Methods: Semi-structured interviews, analyzed via template, immersion and crystallization, and thematic development. Thirty-two participants from Northwestern Virginia representing five groups of caregivers for dementia patients were interviewed: families of community-dwelling, assisted living, and nursing home patients, and nurses from the same assisted living/nursing home facilities. Results: Caregivers described three major themes regarding medications: (a) Systemic barriers exist for non-pharmacologic BPSD therapies. (b) Medications have few barriers, and seem generally effective and safe. (c) When non-pharmacologic measures fail, medications, including antipsychotics, may be necessary and appropriate for palliation of patient distress. Discussion and Implications: To further reduce medications for BPSD, obstacles to services and alternative therapies must be mitigated. Caregiver perceptions that medications are generally safe and effective contribute to their continued use. Guidelines and policies for BPSD management should incorporate the caregiver position that medications, including antipsychotics, are sometimes justified and required to alleviate patient suffering.
Background and Objectives: To avoid "chemical restraints," policies and guidelines have been implemented to curb the use of medications for behavioral and psychological symptoms of dementia (BPSD). Antipsychotics have been particularly targeted because of their rare severe side effects. Consequently, caregiver directed non-pharmacologic therapies have increased while medication use for BPSD has diminished. Despite such initiatives, however, antipsychotics continue to be prescribed "off-label" for roughly 20% of nursing home patients. How caregivers impact management approaches and prescribing decisions for BPSD, including antipsychotic use, is poorly understood. Aim: assesses experiences and perceptions of family and nursing caregivers regarding factors influencing medication decisions for BPSD. Research Design and Methods: Semi-structured interviews, analyzed via template, immersion and crystallization, and thematic development. Thirty-two participants from Northwestern Virginia representing five groups of caregivers for dementiapatients were interviewed: families of community-dwelling, assisted living, and nursing home patients, and nurses from the same assisted living/nursing home facilities. Results: Caregivers described three major themes regarding medications: (a) Systemic barriers exist for non-pharmacologic BPSD therapies. (b) Medications have few barriers, and seem generally effective and safe. (c) When non-pharmacologic measures fail, medications, including antipsychotics, may be necessary and appropriate for palliation of patient distress. Discussion and Implications: To further reduce medications for BPSD, obstacles to services and alternative therapies must be mitigated. Caregiver perceptions that medications are generally safe and effective contribute to their continued use. Guidelines and policies for BPSD management should incorporate the caregiver position that medications, including antipsychotics, are sometimes justified and required to alleviate patient suffering.
Authors: Ariel R Green; Patricia Lee; Emily Reeve; Jennifer L Wolff; Chi Chiung Grace Chen; Rachel Kruzan; Cynthia M Boyd Journal: J Am Board Fam Med Date: 2019 May-Jun Impact factor: 2.657
Authors: Matthew E Growdon; Edie Espejo; Bocheng Jing; W John Boscardin; Andrew R Zullo; Kristine Yaffe; Kenneth S Boockvar; Michael A Steinman Journal: J Am Geriatr Soc Date: 2022-03-10 Impact factor: 7.538
Authors: Barbara Resnick; Ann Kolanowski; Kimberly Van Haitsma; Elizabeth Galik; Marie Boltz; Jeanette Ellis; Liza Behrens; Karen Eshraghi; Shijun Zhu Journal: Clin Nurs Res Date: 2019-04-03 Impact factor: 2.075
Authors: Ariel R Green; Jennifer L Wolff; Diane M Echavarria; Malcolm Chapman; Annie Phung; Devon Smith; Cynthia M Boyd Journal: J Gen Intern Med Date: 2019-11-08 Impact factor: 5.128