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Medication concerns in rest homes.

Medication concerns in rest homes

Rest homes, originally intended as room-and-board facilities for relatively healthy elderly residents, are increasingly taking in patients released from state mental hospitals. One consequence of this trend, according to a report in the Jan. 26 NEW ENGLAND JOURNAL OF MEDICINE, is the widespread use of psychiatric drugs in rest homes, with little medical supervision or understanding by staff members of the potential side-effects of these drugs.

Jerry Avorn and his colleagues of Harvard Medical School in Boston surveyed a random sample of 55 rest homes in Massachusetts. They find 55 percent of the 1.201 residents took at least one psychiatric medication. Thirty-nine percent got antipsychotic drugs; the rest received antidepressants, tranquilizers or lithium (commonly prescribed for manic depresion). Most prescriptions "had been written in the remote past and were refilled automatically," the researchers note.

They then looked at 837 residents of 44 rest homes with particularly high levels of antipsychotic drug use. More than two-thirds of these individuals had spent time in some type of psychiatric facility. Although 82 percent of them were taking one or more antipsychotic durg, medical records showed nearly half had no evidence of physician participation in decisions regarding their mental health care during the previous year.

About 6 percent of the follow-up sample had moderate or severe symptoms of a movement disorder, known as tardive dyskinesia, caused by antipsychotic drugs (SN:7/20/85, p.45). Another 17 percent had mild signs of tardive dyskinesia.

Interviews with rest home staff responsible for patient care revealed that about half were unfamiliar with the purpose-and side-effects of commonly used psychiatric drugs.

One approach to the problem, the researchers say, is to require better training for rest home workers and vigorous monitoring of care by state officials.
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Publication:Science News
Date:Feb 11, 1989
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