February 26th, 2011 at 3:07 am
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New York Times blog post spotlights hands-on care program

by Carol Bursack

Regular readers are aware that I spent close to two decades providing varying amounts of care to beloved elders, often including paid help when needed. Five of my elders spent significant time in a local nursing home.

This home was ahead of its time in providing hands-on care rather than medications, whenever possible, even though at the time there was less evidence than there is now that too many medications can lead to significant decline in abilities of elders. It’s now known that over-medicating can even cause dementia symptoms in elders who are otherwise cognitively fine.

An article on the New York Times New Old Age Blog, titled Clearing the Fog in Nursing Homes, is an eye opener for anyone who doubts that over medicating elders is risky business. In the article, author Paula Span tells the story of a woman in a Two Harbors, Mich. nursing home who couldn’t communicate with words, though she’d continually cry out in an alarming manner.

Span writes: “The Two Harbors home happened to be where Ecumen, which operates 16 nonprofit Minnesota nursing homes, was preparing an experiment to see if behavioral rather than pharmacological approaches could help wean residents off antipsychotic medications. They called it the Awakenings program.”

Span’s well-written article takes a good look at the Awakenings program, which stresses interaction between residents and staff over medication, something that many good nursing homes are trying to implement.

Understaffed nursing homes often resort to drugs to help patients, since staff-intensive programs like Awakenings often dictate more staff time. According to Span’s article, “…the home trained its entire staff…in a variety of tools to calm and reassure its 55 residents…The hands-on, caring part is the most important…Sometimes, people just want a hug.”

As the woman who spent her days crying out was slowly weaned from drugs, Ecumen staff members saw improvement in her ability to communicate. The woman became communicative enough to articulate the fact that she was suffering from acute physical pain. Through the judicious use of appropriate medications, she is now physically more comfortable, and more responsive to life in general.

Awakenings is one of the growing number of programs that demonstrate how hands-on care trumps the over-use of drugs. Little by little, nursing home culture is changing. Yes, medications are needed. Indeed, they are vital to many of these people. However, they must be used carefully, with interactions and dosages carefully controlled, and drugs should not substitute for human interaction and loving care.

Related article: Use of atypical antipsychotics for dementia patients declines according to study

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