"This is the largest study to show that it is possible to reduce antipsychotic use in the nursing home population," said Dr. Tjia. "This intervention focused on treating the residents as human beings with needs, not as patients with problems. We don't medicate babies when they cry or act out, because we assume that they have a need that we need to address. However, when people with dementia are unable to communicate, the current approach medicates them when they have undesirable behaviors."
The off-label prescription of antipsychotics for nursing home residents with dementia is common, despite numerous studies that have shown it increases risk of stroke and death and is only minimally effective in controlling behavioral symptoms of dementia.
Tjia studied the influence of a communication training program called "OASIS" for nursing home staff on off-label antipsychotic use. The OASIS curriculum and training - launched by the Massachusetts Senior Care Association in collaboration with the Massachusetts Department of Health and developed by Susan Wehry, MD,--equips frontline nursing home staff, such as nursing assistants, nurses, dietary staff and receptionists, with the knowledge, skills and attitudes to meet the needs of residents with dementia using nonpharmacologic approaches rather than medication. Ironically, the program reached very few prescribers, but was still able to significantly reduce antipsychotic use.
"The OASIS program asks nursing staff to create care plans that include what residents can do, shifting away from the model that focuses on what they can't do," Tjia said. "This is a fundamental shift in how to think about caring for persons with dementia and we showed that it is effective."