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Editor's e-Note
Longstanding concerns regarding the overuse of antipsychotics for patients with dementia in long term care have prompted nationwide efforts to implement measures aimed at more judicious use of these medications. The Centers for Medicare & Medicaid Services directed that concerted efforts be adopted within nursing homes and has recently indicated that nationally the benchmark of 18% antipsychotic use among these patients has been met.

Diversicare, which operates long term care facilities in nine states, has not only reached the benchmark, but has also reduced its antipsychotic rate in this population to 12% in 54 centers, resulting from a program designed and implemented specifically to curtail antipsychotic use among dementia patients.

Diversicare’s program has successfully lowered the incidence of antipsychotic use, and with this achievement have come additional benefits. And patients are the biggest beneficiaries in this effort.

In addition to reading our e-newsletter, be sure to visit Today’s Geriatric Medicine’s website at, where you’ll find news and information that’s relevant and reliable. We welcome your feedback at Follow Today’s Geriatric Medicine on Facebook and Twitter, too.

— Barbara Worthington, editor
e-News Exclusive
Reducing Use of Antipsychotics in Nursing Home Patients With Dementia
By Jaimie Lazare

The use of antipsychotics to manage psychosis-related symptoms in elderly patients with dementia is associated with increased morbidity and mortality. Despite warnings about their harmful effects, these drugs continue to be administered. The Centers for Medicare & Medicaid Services (CMS) launched a national campaign to reduce antipsychotic use in nursing homes.

Approximately one-third of elderly nursing home patients diagnosed with dementia are prescribed an antipsychotic medication to manage psychosis-related symptoms such as delusions, hallucination, aggression, and agitation.1 Antipsychotics, however, are not indicated for use in these patients and have been linked to heart failure, stroke, infection, and death. In one study, researchers used data taken from Medicaid-eligible long-stay residents in seven states and found that about 52% of residents were administered an antipsychotic without an approved CMS/FDA indication.2 The FDA requires drug manufacturers to include warning labels to alert prescribers about the increased risk of death when antipsychotics are used in patients with dementia.

Full story »
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Promoting Patient Health Through 2016

On the corner of my home computer is a small piece of paper cut from an old copy of Investor’s Business Daily (IBD). It contains IBD’s 10 Secrets to Success. In every issue is a “Top 10” list of items their experts encourage investors to review. But the advice is not specifically investment related; it is, in fact, investor related. The items listed below are keys to individual investor behaviors that, in sum, lead to success.

I keep that paper there to remind me of the value of continuous quality improvement. It’s a visual reminder of the value of working constantly to upgrade knowledge, skills, and abilities in a topic area. It reminds me of the value of naming the challenge, identifying steps in a difficult process, and ultimately finding the oft-untapped potential of renewed effort. All are key messages for those of us in the business of personal training. Changing human behavior and thought processes is critical for clinical success, yet we don’t yet have surefire ways to successfully manage the change.

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Q: What is the difference between Clostridium difficile (C diff) toxin and antigen? What are the recommendations on treatment?

DeEsta Howard
Nim Henson Geriatric Center
Jackson, Kentucky

A: C diff can produce toxins that attack the lining of the intestine. The toxins destroy cells and produce patches (plaques) of inflammatory cells and decaying cellular debris inside the colon and cause watery diarrhea.

Testing is often a combination of the following two assessments:

• Antigen detection for C diff: These are rapid tests (under one hour) that detect the presence of C diff antigen by latex agglutination or immunochromatographic assays. Because results of antigen testing alone are nonspecific, antigen assays have been employed in combination with tests for toxin detection, polymerase chain reaction, or toxigenic culture in two-step testing algorithms.

• C diff toxin: The toxin degrades at room temperature and may be undetectable within two hours after collection of a stool specimen. False-negative results occur when specimens are not promptly tested or are kept refrigerated until testing can be done.

Antibiotics can be used for treatment. For mild to moderate infection, metronidazole (Flagyl) is taken by mouth. Metronidazole is not FDA-approved for C diff infection but has been shown to be effective in mild to moderate infection. Side effects of metronidazole include nausea and a bitter taste in the mouth. For more severe and recurrent cases, vancomycin (Vancocin), also taken by mouth, may be prescribed. Another oral antibiotic, fidaxomicin (Dificid), has been approved to treat C diff.

Recommended sites for further reading include the Mayo Clinic and the Centers for Disease Control and Prevention.

Note: This information is not intended as a substitute for professional medical advice, diagnosis, or treatment. For questions regarding specific medical conditions, seek the advice of a physician or other qualified health care provider.

— Rosemary Laird, MD, MHSA, AGSF, is a geriatrician, executive medical director of senior services for Florida Hospital at Winter Park, and past president of the Florida Geriatrics Society. She is a coauthor of Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One With Memory Loss.
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