When it comes to memory care, senior living providers are taking a hard look at how to reduce the number of medications that residents are taking.
This is in part because of a years-long push among providers and other stakeholders to reduce the use of antipsychotic medications, which may have serious negative consequences for seniors with dementia, including an increased risk of death. Comprehensive new regulations for the skilled nursing sector recently proposed by the government also would formally require certain best practices to bring down antipsychotic usage.
Almost all people suffering from dementia (90%) will exhibit behavioral or psychological symptoms, according to the United Kingdom-based Alzheimer’s Society. Where once patients may have been given medication automatically to reduce challenging behaviors like agitation, anxiety and aggression, more operators in senior living settings are pushing for different methods. Engagement is the name of the game for dementia caregivers.
Enter innovation. Here are three examples of how cutting-edge providers are already helping reduce medication use in memory care:
Tablets for Meaningful Days
In 2015, the tablet is ubiquitous. And today, everyone and their mother can be using iPads and similar technologies to make life better or easier.
The SimpleC Companion is designed to be an intuitive tablet for personal use that dementia residents can use as part of their daily lives. Using music, visual cues and timely prompts reminding seniors when to eat, exercise or brush their teeth, the product is meant to help seniors to become stimulated and engaged with the technology throughout the day.
A senior using the SimpleC receives a visual cue, such as a photograph of a meal during meal times, or photos of family members with personalized recordings that would prompt them to perform a task or engage them in a stimulating activity. The SimpleC Community Connect uses musical therapy and visual cues in group settings to engage several people at a time, resulting in less agitation and anxiety for some.
Frank Farrow is the COO of Chattanooga-based senior living owner/operator Morning Pointe, which offers assisted living and Alzheimer’s memory care with locations in Tennessee, Kentucky, Georgia, Alabama and Indiana. Morning Pointe communities adopted SimpleC products two years ago as part of their memory care regimen, called the Meaningful Day program. Focusing on the body’s natural rhythms, Morning Pointe aims to reduce medications by utilizing a routine, ensuring that seniors eat, exercise and do activities at the same time each day to cue the body to respond.
Farrow says the effects of SimpleC products have been very beneficial and apparent, and some residents are able to reduce their medications as a result. The biggest implications have been for “sundowners,” or dementia care residents who become increasingly agitated as the day wears on.
“We find that there is a significant reduction in medications when re-directing to SimpleC,” says Farrow. “Instead of medicating during the evening, we are able to travel around the world, work puzzles, play games, listen to music and do many other activities with Community Connect. Working with sundowners is where we see the significant difference. Where they were medicated to help them cope in the evening, they are now re-directed to something that captivates their attention.”
For Morning Pointe, reducing medication use is a cornerstone of their memory care philosophy.
“Anytime we can put in some type of interventions without any use of medications or drugs, it’s a win-win for the families, the resident and us as the care provider,” he says. “It’s a time saver. It’s better health and wellness. It’s less money for the family.”
More Singing, Less Stress
Karaoke is a hit in memory care with a music therapy product called SingFit. SingFit has already partnered with Five Star Senior Living, a national operator with more than 260 senior living communities in 30 states, as well as West Coast providers Eskaton Senior Living Communities and Aegis Living.
Instead of reading lyrics, seniors engage in music therapy by singing along with familiar songs using lyrics that are audibly prompted for them. The SingFit program also promotes movement, with visual cues and trivia in group settings. Staff members are trained to conduct sessions to ensure seniors are getting the best therapeutic results.
As seniors engage with the program, they can experience mood elevation by reducing stress and anxiety just from singing and going through the process, says SingFit co-founder and certified music therapist Andy Tubman. Less stress leads to fewer medications for some patients.
Katy Krul with Oxnard Family Circle, an adult day health care center in Oxnard, California, has found SingFit to work “wonders” for some program participants. Staff would do everything they could to reduce anxiousness and agitation before turning to medication, such as taking seniors for walks, but nothing worked well until they discovered SingFit.
“As we discovered SingFit, we decided to get to the programs at certain times, and that changed it all,” says Krul. “People really respond to it well. They will not remember what they knew before, absolutely not, but the anxiety, the urge to pace, that is very well controlled.”
For a few participants, SingFit has been a crucial part of medication reduction.
“Out of five days a week he is here, we administer medication maybe once a week,” Krul says of one of her participants. “It’s a huge reduction.”
SingFit is quickly rolling out to more communities with positive results. A 12-week pilot program across 11 senior living communities revealed that 43% of participants who tried SingFit between one and seven times per week experienced mood elevation.
Eighty-one percent of residents in the pilot program, on average, sang between sometimes and often during a SingFit session. While it may not seem like much, getting residents to talk and engage more can have a profound impact on their behavior.
“It’s designed as a therapeutic process not as an activity,” says Tubman. “Everything from the lighting, the room and training and engagement tips – everything is designed for the deepest level of engagement and positive therapeutic [value].”
Theater therapy might not seem like the right approach for those with dementia, but seniors don’t have to memorize any lines with Scripted IMPROV, a drama program based on an easy-to-follow play.
With a theme for a play rather than words, everyone can get involved and help build the experience of the theater at whatever level they can participate. Promoting laughter and mood elevation, Scripted IMPROV is a non-drug therapy making the rounds in senior living.
Natalie MacBrien, Chief Health Operator at Edgewood LifeCare Community in Massachusetts, says Scripted IMPROV has become an integrated part of their memory care philosophy. Edgewood was the first community to be award the Hearthstone Foundation’s I’m Still Here Center of Excellence Award for its focus on using behavioral methods over pharmacological interventions to improve the lives of its memory care residents.
Memory care residents and staff members alike took part in the Scripted IMPROV pilot program, and the reaction “blew them away,” says MacBrien. From building the props and hosting a tropical punch night to build off the pirate theme of the IMPROV play, residents became so engaged in the program that family members were astonished.
“It was just so gratifying for them to be able to see their loved one participating and enjoying when they hadn’t seen things like that before,” says MacBrien. “They saw glimpses of the parent that they knew. That was the best part.”
The results of using theater therapy are also measurable.
Since adopting the I’m Still Here approach and adding Scripted IMPROV to the community, anti-psychotic medication use has been reduced at least 27%, says MacBrien.
“Medications are the absolute last resort, and we work very hard to use engagement to find the person that is there and building those relationships with the resident and with the staff,” says MacBrien.
Written by Amy Baxter