Behavioral Reactions to Psychotropic Medication Changes for Nursing Home Residents Receiving Psychogeriatric Programming

Abstract

Initiation of programming for mentally ill nursing home residents made it possible to examine the effect of changes in psychoactive medications on their behavior. These changes in psychotropics were a central aspect of the medication management component of a psychogeriatric rehabilitative program. Despite the nationwide debate concerning the use of medications in controlling nursing home residents, some staff members criticized medication reductions as leading to psychiatric instability. Compared to 34 residents of a "waiting list" nursing home, 99 residents at three facthties with psychogeriatric programming did receive many more changes in medicattons, especially reductions. But these medication decreases were not associated with more behavioral problems during the 31-week observation period. Behavioral difficulties were measured by a weighted sum of restraint usage, incident reports, and pro re nata (PRN) medications. Simplified time-series analysis (STSA) indicated that behavioral difficulties had been mounting prior to increases in medications, decreases in medications, and changes in drug category. Although there was a temporary rise in behavioral problems for 2 weeks after medication decreases, behavioral difficulties were reduced within 8 weeks of all types of drug changes. This article compares the observed jump in behavioral difficulties to "extinction bursts" and discusses the relationship between rehabilitative programming, staff consistency, and psychotropic adjustments.

Get full access to this article

View all access options for this article.

References

Blazer, D.G. , Federspiel, C.F. , Ray, W.A. , & Schaffner, W. (1983). The risk of anticholinergic toxicity in the elderly: A study of prescribing practices in two populations. Journal of Gerontology, 38, 31-35.

Casey, D. E. , & Gardos, G. (Eds.). (1986). Tardive dyskenesia and neuroleptics: From dogma to reason. Washington, DC: American Psychiatric Press.

Fitz, D. , & Simon, J. (1985). Evaluation of psychotropic medication changes for Project Adapt clients-Part 1: Extent, frequency, and consistency of changes (Report No. 66. St. Louis: St Louis Regional Community Placement Program.

Goldman, H.H. , Feder, J. , & Scanlon, W. (1986). Chronic mental patients in nursing homes: Reexamining data from the National Nursing Home Survey. Hospital and Community Psychiatry, 37, 269-272.

Hartlage, L.C. (1965). Effects of chlorpromazine on learning. Psychological Bulletin, 64, 235-245.

Hicks, R. , Dysken, M.W. , Davis, J.M. , Lesser, J. , Ripeckyj, A. , & Lazarus, L. (1981). The pharmacokinetics of psychotropic medication in the elderly: A review. Journal of Clinical Psychiatry, 42, 374-385.

Kalchthaler, T. , Coccaro, E. , & Lichtiger, S. (1977). Incidence of polypharmacy in a long-term care facility. Journal of the American Geriatrics Society, 25, 308-313.

Kashgarian, M. (1980). On drug usage in nursing homes [Letter to the editor]. American Journal of Public Health, 70,1217-1218.

Kazdin, A.E. (1984). Behavior modification in applied settings (3rd ed.). Homewood, IL: Dorsey Press.

10.

Lamy, P.P. (1980). Misuse and abuse of drugs by the elderly: Another view. American Pharmacy, 20, NS14-NS17.

11.

Learoyd, B.M. (1972). Psychotropic drugs and the elderly patient. The Medical Journal of Australia, 1, 1131-1133.

12.

Mallya, A. , & Fitz, D. (1987). A psychogeriatric program in long-term care facilities . The Gerontologist, 27, 747-751.

13.

Martin, G. , & Pear, J. (1988). Behavior modification: What it is and how to do it (3rd ed.). Englewood Cliffs, NJ: Prentice-Hall.

14.

Nie, H. , Hull, C.H. , Jenkins, J.C. , Steinbrenner, K. , & Bent, D.H. (1975). Statistical packages for the social sciences. New York: McGraw-Hill.

15.

Paul, G.L. , Tobias, L.L. , & Holly, B.L. (1972). Maintenance psychotropic drugs in the presence of active treatment programs: A "triple blind" withdrawal study with long-term mental patients. Archives of General Psychiatry, 27, 106-115.

16.

Rango, N. (1982). Nursing-home care in the United States: Prevailing conditions and policy implications. New England Journal of Medicine, 307, 883-889.

17.

Ray, W.A. , Federspiel, C.F. , & Schaffner, W. (1980). A study of antipsychotic drug use in nursing homes: Epidemiological evidence suggesting misuse. American Journal of Public Health, 70, 485-491.

18.

Reynolds, M.D. (1984). Institutional prescribing for the elderly: Patterns of prescribing in a municipal hospital and a municipal nursing home. Journal of the American Geriatrics Society, 32, 640-645.

19.

Sandifer, M.G. (1985). Drugs in nursing homes [Letter to the editor] . Hospital and Community Psychiatry, 37, 291.

20.

Schmidt, L.J. , Reinhardt, A.M. , Kane, R.L. , & Olsen, D.M. (1977). The mentally ill in nursing homes: New back wards in the community. Archives of General Psychiatry, 34, 687-691.

21.

Talbot, J.A. (1988). Nursing homes are not the answer. Hospital and Community Psychiatry, 39, 115.

22.

Thompson, T.L. , Moran, M.G. , & Nies, A.S. (1983). Psychotropic drug ase in the elderly. New EnglandJournal of Medicine, 308, 134-137.

23.

Tryon, W.W. (1982). A simplified time-series analysis for evaluating treatment interventions. Journal ofApplied Behavior Analysis , 15, 423-429.

24.

Vestal, R.F. (1982), Pharmacology and aging. Journal of the American Geriatrics Society, 30, 191-200.

25.

Waxman, H.M. , Klein, M. , & Carner, E.A. (1985). Drug misuse in nursing homes: An institutional addiction? Hospital and Community Psychiatry, 36, 886-887.