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.