GAO report blasts use of antipsychotics

Reports of excessive antipsychotics’ use in nursing homes have circulated for years. But a new study from the federal government suggests that assisted living communities also are at fault.

A report from the General Accountability Office calls for greater oversight in senior living communities beyond skilled care settings.

Nearly a third of elderly dementia residents spending more than three months in nursing homes wind up taking the powerful drugs, GAO investigators found after combing through databases of the Medicare Part D prescription drug program. But a smaller yet no less disturbing number (14%) of dementia patients are also getting prescribed antipsychotics in home settings and assisted living facilities, the GAO noted.

The study found that while the drugs may be appropriately prescribed to address patients expressing agitation or delusions, they have been shown by the Food and Drug Administration to pose an increased risk of death in people suffering simultaneously from dementia and psychosis. 

Sen. Thomas Carper (D-DE) said the report shows that “many seniors with dementia are receiving risky mind-altering medications.” The GAO report acknowledges that HHS agencies already are addressing antipsychotic drug use by older adults in nursing homes under the auspices of the National Alzheimer’s Plan, but none of those efforts have been focused in settings like assisted living facilities.

Pain assessment blast 

Caregivers have no reliable means to gauge pain in dementia patients, university researchers maintain while calling for new methods to assess chronic pain in those populations.

While verbalizing experienced pain levels is the gold standard for caregiver assessments, no such standard exists for dementia patients, researchers in the United Kingdom and New York reported in the journal BMC Geriatrics.

Another smoking risk

Exposure to smoke from just one cigarette decreases blood flow to chronic wounds such as pressure ulcers, venous leg ulcers and diabetic foot ulcers. A new study shows the habit’s impact on healing is rarely discussed with patients. 

Researchers from The Ohio State University School of Nursing examined how smoking affects the wound healing process and found chronic wounds share common characteristics of inflammation and reduced blood flow that make them particularly susceptible to the approximately 4,000 toxic chemicals found in cigarette smoke.

“The deep skin wrinkling associated with chronic smoking is caused by chemicals that impact the production of collagen, a protein that is also critical to the wound repair process,” said Jodi McDaniel, Ph.D., CNP, a study co-author. 

For med substitution

Drug substitutions saved the government $13 million last year, but more drug substitutions under Medicare Part B would have saved an additional $6 million, the Office of Inspector General for Health and Human Services concluded in a recent report to Congress. 

Under the Centers for Medicare & Medicaid Services’ price substitution policy, 15 drug codes were subject to reimbursement reductions on the basis of data from 2013, according to an OIG report released February 27. 

“We estimate that if CMS had expanded its price substitution criteria to include drug codes with complete average manufacturer price data in a single quarter or certain codes with partial AMP [average manufacturer price] data, the agency could have generated almost $6 million in additional savings,” OIG authors noted.

New fasting benefits

Periods of fasting could be one way to sidestep some chronic illnesses such as diabetes, and add years to one’s life. Meanwhile, consecutive daily fasting supplemented with antioxidants could hinder those perceived benefits, University of Florida researchers said.

In a study published in the journal Rejuvenation Research, the group concluded that intermittent fasting caused a slight increase to SIRT 3, a well-known gene that promotes longevity and is involved in protective cell responses, said Harvard Medical School doctoral candidate Michael Guo. Such fasting also was found to lower insulin levels.

Screenings challenge 

British researchers warned that routine screening for abdominal aortic aneurysms in over-65 males may be doing more harm than good.

Detection rates for AAAs boomed after formal screening methodologies became commonplace in the 1980s, but they’ve done very little to prevent overall mortality rates, scientists argue in the British Medical Journal

What’s the catch?

Catching a weighted medicine ball can improve balance and could help prevent falls in the elderly, according to two studies from the University of Illinois at Chicago.

Principal Investigator Alexander Aruin, Ph.D., a professor of physical therapy, has been studying whether special training or exercises could enhance the kinds of anticipatory adjustments people typically make to help prevent falls. The elderly are less likely to anticipate falls and/or absorb jostling.

Aruin and his colleagues asked a group of healthy young adults to stand and catch a medicine ball. In a second study, they asked the same of a group of healthy older adults. The researchers measured the electrical activity of leg and trunk muscles to look for differences in the two age groups’ ability to make postural adjustments both before and after a single short training session.