Antipsychotics in assisted living

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Vice President and Corporate Medical Officer of Presbyterian Senior Living
Vice President and Corporate Medical Officer of Presbyterian Senior Living

You've undoubtedly heard the adage: “Strength in numbers.” Now consider the "numbers" generated by your "resident health data" in your assisted living community. There is mountain of strength in the data these numbers generate that are opportunities to help your AL excel.

The following is an example of the strength and importance of AL resident health numbers:

The authors of the recent GAO report detailing the use of antipsychotics in dementia residents living in nursing homes have recommended that the U.S. Department of Health and Human Services expand oversight to the assisted living industry. The latter, however, is hampered in responding to the potential regulation that such a review threatens because of lack of current data in their industry describing the use of these medications. How are they to respond when data that describe the baseline prevalence of these medications as well as other resident health issues are not forthcoming?

To address this concern, ACRA offers our experience with de-identified health data of 3,175 current AL residents living in 90 different ALs. The prevalence of antipsychotic medications among the 2,404 AL residents with dementia is 37 percent. However, what is striking is that the prevalence among 771 AL residents without dementia is also 37 percent. This context is important, as it implies that dementia residents are not singled out as a selected class of vulnerable individuals who are prescribed these medicines. It does support the experience and clinical challenge faced every day by workers who care for vulnerable seniors who have problematic behaviors that may be difficult to control and require intervention. To be sure, there is no ‘one-size-fits-all' approach, and multimodality tactics that address troubling behavior are warranted. However, medications, even antipsychotic medications, should not automatically be viewed as “the enemy”, as their appropriate use conveys very real benefits that may outweigh their very real risks.

Another striking finding in our database of 3,175 AL residents is the remarkable variability in the prevalence of antipsychotics among the different ALs. The figure at left shows that the prevalence ranges from 6 percent of residents to 97 percent of residents, depending on the AL. Although the figure includes data combined for dementia and non-dementia residents, the variability for each of these subgroups individually is similar. This emphasizes the importance for each AL to make its own assessment of antipsychotic prevalence in its community, as the priority of quality review projects in the "low prevalence ALs" may be more beneficially directed to other areas.

Finally, there is great value in the assisted living industry proactively participating in and supporting resident health research. At the very least, and with the aid of a research consultant, it allows the AL industry to engage in discussions of important resident health issues with data-driven dialogue. It also identifies customized, targeted areas for quality improvement initiatives that will benefit AL communities and their residents.

The message to the AL industry is: you already have “strength in numbers.” Your data are your strength.

Steven Fuller, Ph.D., DO, is the chief medical officer at ACRA (Affinitas Center for Research and Analytics), which uses a unique and proprietary analytic system and research database applied to state-of-the art senior housing health analytics.  


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