May 25, 2013

Maine nursing home's drug-free dementia treatment a model

An Alzheimer’s patient in a Waterville nursing home improves markedly without prescribed medication.

By Matt Hongoltz-Hetling mhhetling@centralmaine.com
Staff Writer

WATERVILLE - When Vicki Dyer became the program administrator for the newly opened 32-bed dementia ward at Lakewood nursing home in 2006, she wasn't happy with the amount of suffering she saw.

click image to enlarge

Gerald "Jake" Ellis, 79, reaches for the hand of his wife, Pauline Ellis, 79, in the chapel at Lakewood Nursing Home in Waterville Wednesday. A resident of the home's dementia ward, Pauline Ellis has enjoyed improved quality of life after being taken off antipsychotic drugs.

Michael G. Seamans / Morning Sentinel

As in many nursing homes, residents who were disoriented, frightened and frustrated by their inability to recognize people or their surroundings and became difficult to handle were medicated as a way of calming them down.

It's a situation that frequently plays out in nursing homes, which care for some of the 25,000 Maine residents who have been diagnosed with Alzheimer's disease. When residents express themselves by frequent crying, or pushing away well-meaning caregivers, or even simply by wandering around to explore their surroundings, the response over the past few decades has sometimes been to stifle that behavior by medicating the resident into a stupor.

"We need a better approach," Dyer recalled saying.

Nursing home residents with dementia are "vulnerable to us," she said recently. "They're at our mercy."

Today, the nursing home has eliminated antipsychotic drugs from its dementia ward.

That move has made it a national health care model.

National health care leaders have been working to prevent the overmedication of seniors since 2005, when a report from the Food and Drug Administration showed they may have a lower quality of life and even die from some antipsychotic medications, which can cause heart failure and pneumonia.

JAKE AND PAULINE

Jake Ellis married his high school sweetheart, Pauline, in the early 1940s, when they were just 17 years old.

Jake, whose given name is Gerald, worked for most of his life as a plant manager, while fun-loving Pauline raised their five children.

The favored remedy for an ill-behaved child back then was to "give them a slap on the ass and set them on the chair," she said.

Jake said his wife always made the time to do the cooking, the canning, and everything else.

It wasn't always a fairy-tale romance, he said, but a good, solid marriage that lasted through the decades.

"It weren't easy, but we got along," he said. "We got by. We had our hard times, but we had our good times, too."

But when they were living in Dexter, with the children grown, Alzheimer's struck, removing some of the luster from their golden years.

It could have been Jake. As it turned out, it was Pauline.

Or perhaps it would be more accurate to say that the frightening disease afflicted them both.

Pauline began wandering. Jake was increasingly worried about her slipping off and getting lost or hurt without him realizing it.

Desperate, Jake asked Pauline's doctor for advice. The doctor recommended Seroquel, a mood-stabilizing medication. According to the FDA, Seroquel's possible side effects include weakness, risk of suicidal thoughts and actions, abdominal pain and an increased risk of stroke, which can lead to death in elderly people with dementia. Because of the increased risk of death, the FDA specifically warns against using the drug to treat elderly people with dementia.

The medication didn't help Jake and Pauline. He locked the doors, but she unlocked them. He began sticking a butter knife into the gap between the door and the doorjamb, to make it harder for her to get the door open. Sometimes, she tried to get out the window.

"I really couldn't handle her," he said. "She'd get up in the middle of the night, like, and she'd get outside and wander down the driveway, and I found her in the snow, barefooted. We lived right beside the lake. It was really scary."

TREATING WITHOUT DRUGS

When Jake took Pauline to Lakewood, he didn't realize it, but Dyer's campaign to reduce patient medication was in full swing.

(Continued on page 2)

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