McKnight’s had an article about FDA concerns over the use of Nuedexta as a chemical restraint.  Nuedexta is the only drug approved to treat uncontrolled laughing and crying due to pseudobulbar affect.  However, some nursing homes are using it for residents without pseudobulbar affect.   It’s a rare condition yet the U.S. government is cautioning private insurers to look for suspicious off-label use there because officials fear the drug is being misused to control behavior.

A CNN investigation published in October found Nuedexta’s maker had been “aggressively targeting frail and elderly nursing home residents for whom the drug may be unnecessary or even unsafe.”   CNN unearthed what seems to be a concentrated effort to keep the increasingly controversial drug in nursing home’s formularies.  The station obtained complaints sent to the Food and Drug Administration from insurers and nursing home physicians who questioned the maker’s marketing and advertising tactics.

In a follow-up article published Monday, the news organization said the Centers for Medicare & Medicaid Services issued a March memo asking Medicare Part D providers to monitor prescriptions for appropriate use.

The CMS memo told plan sponsors that Nuedexta is only approved to treat pseudobulbar affect, and that they are legally required to ensure the drug is only covered for medically-accepted prescriptions. Neudexta’s maker, Avanir Pharmaceuticals, has said that dementia patients may suffer from PBA.  No medical research supports that contention.  Since the drug launched in 2011, CNN reports Avanir has generated millions of dollars in annual sales in nursing homes.

Fox25Boston reported a tragic incident that occurred at a Rhode Island nursing home.  Frank Palin, age 67, was arrested for sexually assaulting a patient with dementia in a nursing home. Palin is charged with a single count of indecent assault and battery on a person over age 65, stemming from an incident through his work with Old Colony Hospice.

According to the police report, on May 19th, Palin showed up to Cornerstone without an appointment, asking and employee to unlock the secured facility where the victim stays.  According to authorities, the woman’s children had installed a video camera inside her room, so they could check in on her, which helped them find out what was happening.

Palin is a contract employee with Old Colony but was working as a nurse practitioner at Cornerstone at Canton, where the victim is a resident of the facility. She reportedly suffers from dementia and lives in the memory care unit at Cornerstone.

Bob Larkin, the president of Senior Living Residences, the management company in charge of operations at Old Colony Hospice and Cornerstone at Canton, issued the following statement on Friday afternoon:

“The alleged violation of a vulnerable elder is appalling beyond words. We support the victim’s family and the police department in seeking criminal prosecution to the fullest extent of the law. Nothing is more important to us than the safety and well being of our residents. The accused nurse practitioner was not an employee of our company; he worked for a third-party local hospice agency that has no contractual or other relationship to our assisted living community. Any questions about the individual’s employment or exact duties should be directed to his employer, Old Colony Hospice in West Bridgewater, 321 Manley St, West Bridgewater, MA,  781-341-4145. Also please call the Canton Police for any information about the ongoing investigation. Please note, HIPAA patient privacy and confidentiality standards preclude me from providing specific information about any resident. “

Western Slope Now had an interesting article on a new treatment at the Palisade Life Center.  The nursing home is taking Alzheimer’s and Dementia treatments line by line and stanza by stanza.  They’re using poetry to exercise the minds and creativity of the patients in their care.  The group meets once a week to create poems, reaching back into their memories and emotions in a way to express themselves and communicate.

“You can really just see it in their eyes when things are clikcing and coming together,” Caleb Ferganchick, the life engagement coordinator at the center, said, “it allows them the space to share their memories in a structure way to engage and structure conversation that they otherwise wouldn’t be able to do themselves.”

“Actually stimulating the brain,” Jennifer Sims, the specialty programs director for Sava Senior Care, the parent company for the facility in Palisade, said, “Our brain is no different than a muscle in that sense that  if we use it, it’s going to slow the progress of the disease.”

The poems have been created into a book for a self-published collection.

“We took all of the poems we created and we created kind of an anthology called “My Father is in the Arbor” Ferganchick, who started the poem program, said. “It’s named after one of the poems in the book that I really liked.”

The book is for sale online at http://www.blurb.com/b/8750722-my-father-is-in-the-arbor

The profits benefit the residents in the Alzheimer’s and Dementia facility at the Palisade Life Center.

ABC6OnyourSide had an article about three nursing home employees indicted on charges that include involuntary manslaughter, forgery and gross patient neglect in the Jan. 7 death of 76-year-old Phyllis Campbell.  The three employees at Hilty Memorial Nursing Home in Pandora were on duty when a nursing home resident wandered off and died of hypothermia in January.

A state investigation found that Campbell left the facility around 12:30 a.m. Jan. 7 through a courtyard door equipped with an alarm. A device she wore apparently failed to alert workers. The low temperature that night was zero degrees.

 

 

Newsweek had an article about a new study finding evidence to suggest that Alzheimer’s begins in childhood, with babies younger than a year old displaying signs of the disease. The research emphasized that earlier intervention is necessary to prevent the disease and addressing air pollution may play a key role.

Researchers examined the autopsies of 203 residents of Mexico City and published their findings online in Environmental Research. The bodies ranged in age from 11 months to 40 years old.

The researchers specifically looked at levels of two abnormal proteins associated with Alzheimer’s—hyperphosphorylated tau and beta amyloid. Many of the bodies displayed heightened levels of these two proteins in the brain, even in children less than a year old. Evidence of early signs of Alzheimer’s disease was found in 99.5 percent of the subjects examined.

The study theorized that exposure to air pollution may be behind these heightened abnormal protein levels in young brains. Children exposed to cleaner air performed better in various categories, including cognitive performance, lead study researcher Dr. Lilian Calderón-Garcidueñas, a professor in the department of biomedical and pharmaceutical sciences at the University of Montana, told Newsweek. Calderón-Garcidueñas, who also collaborates with Universidad del Valle de Mexico, compared children by age, gender, socioeconomic status, the IQ of their mother, nutrition and education.

See article about the tragic and preventable death of a long time nursing home resident.  Mark Billiter died as a result of the nursing home’s failure to realize and communicate to police that he was missing from the nursing home.  Billiter suffered from a heart attack-induced dementia which made him confused and wander away from the nursing home.  Police reports  indicate he used the elevator security code and walked out while following another patient’s visitor.  A nursing home staff member ushered them both out, the reports show.The nursing home is required to supervise him to keep him safe.

Billiter had slipped out the care facility where he had lived for years. Billiter had not been reported missing by the time a Canton police officer encountered him hours later.  The police found him but no one informed them he was missing from a nursing home.  They drove him to the city limits. National Weather Service records show the temperature dropped to 32 degrees and was below freezing Monday into Tuesday with a wind chill consistently in the 20s.  He was found dead there two days later.

“This is a person who has obviously lived in a sheltered care facility for three years and is now outside …,” said Tracey Laslo, the family’s attorney. “He lacks cognition to live outside of a nursing facility. This was supposed to be a safe harbor and a place of protection for him.  He was a known risk. That’s the reason he was in a secured unit,” she said.

“If the nursing facility had reported this to the family and to police, this tragic ending would not have happened. The police would’ve been able to secure him and return him, and Mark would’ve been OK at this point. The travesty in this case is the nursing home did not follow (its) own policy. There should’ve been an immediate perimeter check of the facility by the staff, the family should have then been contacted so that they could assist and the police should’ve been contacted.”

Kathryn Price’s blog had an article on the use of anti-psychotics in nursing homes despite the FDA’s black box warnings.  Human Rights Watch, a nonprofit, nongovernmental human rights organization, released a report this year that shows nursing homes are overprescribing antipsychotic drugs to manage the behavior of dementia patients even though anti-psychotic drugs are not FDA approved as treatment for dementia.

The FDA mandates that a black box warning appear on anti-psychotic medications, which cautions that they may lead to an increased risk of death for dementia patients. Additionally, research exists supporting the idea that anti-psychotics can be harmful when used for behavioral reasons alone on dementia patients, including an increased risk of death, falls, and reduced cognitive functioning.

The federal government does have regulations aimed at preventing this. One such regulation appears in a 2016 revision to the Centers for Medicare & Medicaid Services’ (CMS) regulations for Medicare and Medicaid certified nursing facilities. The regulations state that “Residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record.”

According to federal regulations, patients and/or their guardians have a right to understand the purpose of their prescribed medical treatment prior to administering, which is vital to preventing the prescription of unnecessary anti-psychotic drugs.

Despite these regulations, the report maintains that anti-psychotic drugs are still used to treat behavioral concerns in dementia patients due to a lack of enforcement. A 2014 NPR report indicates the penalties that exist for unnecessary prescriptions are rarely used and of the infractions reported only 2 percent were severe enough to warrant a fine.

CMS launched a program in 2012 to combat the improper usage of antipsychotic drugs in nursing homes and by late 2016, CMS announced that it met its goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 30 percent.

 

 

Advance directives are legally recognized documents that specify care if a person is incapacitated. They can confirm that a patient doesn’t want to be resuscitated or kept on mechanical life support, such as a ventilator or feeding tube, if they have a terminal condition from which they’re not likely to recover.

The National Review had an interesting article discussing an NPR story on “aggressive advance directive” that would force nursing homes to starve dementia patients — even if they are willing and able to eat — when they reach a specified stage of cognitive decline. The directive, finalized by the board for End Of Life Choices New York, aims to provide patients a way to hasten death in late-stage dementia, if they choose.

The document offers two options. One option is a request for “comfort feeding” — providing oral food and water if a patient appears to enjoy or allows it during the final stages of the disease. Another alternative would halt all assisted eating and drinking, even if a patient seems willing to accept it.  The options would be invoked only when a patient is diagnosed with moderate or severe dementia, defined as Stages 6 or 7 of a widely used test known as the Functional Assessment Staging Tool (FAST). At those stages, patients would be unable to feed themselves or make health care decisions.

 

The Fresno Bee reported on the nursing home resident of Bella Vista Memory Care Community who contends that he had to have his right eye removed after staff at the nursing home allowed him to be attacked twice by his roommate.  Josh Dansby Jr. is seeking compensation for injuries suffered as a result of the facilities failure to protect him.  The lawsuit says Bella Vista is understaffed and has a history of being issued deficiencies by the California Department of Social Services.

Sierra Meadows Senior Living, LLC runs Bella Vista and has called the lawsuit a “shakedown”.

The lawsuit states that Dansby suffers from Alzheimer’s and dementia and has a history of strokes and heart attacks. Around February 2017 he became a resident of the nursing home.  Bella Vista placed Dansby with a roommate who had a known history of aggressive propensities and physical assault.  In September, the roommate attacked Dansby.

After this assault, Dansby’s family complained to the Bella Vista staff, asking that Dansby be protected from the roommate including moving rooms or changing roommates. Bella Vista refused to make any changes.

Dansby was attacked by his roommate again in December. After the attack, Bella Vista staff did not provide Dansby with care for days. He was later taken to Saint Agnes Medical Center’s emergency room, where he was determined to have suffered a corneal detachment. Doctors removed Dansby’s right eye.

 

 

Newsweek reported that a new study published online in Acta Neuropathologica suggests that eight young adults who developed serious brain plaque buildup may have been “infected” with amyloid proteins via dirty medical instruments during brain surgeries in their youth.

Brain plaque buildup is one of the most recognized characteristics of Alzheimer’s disease, as well as other neurodegenerative diseases, such as Creutzfeldt-Jakob Disease (CJD), also known as “human” mad-cow disease, New Scientist reported. Eight patients in England experienced brain plaque buildup caused by excessive amyloid proteins so severe it caused blood vessels in their brain to burst.

Researchers from University College London reviewed the cases of eight young patients who had experienced cerebral amyloid angiopathy (CAA), a condition where amyloid proteins build up in blood vessels in the brain. Not only are both CAA and Alzheimer’s disease both characterized by brain plaque buildup, but both illnesses are also found in much older patients. All eight patients were under 60-years-old, therefore not yet at risk for brain plaque buildup. In addition, none of the patients were at predisposed genetic risk for this disease, New Scientist reported. Instead, the researchers found these patients shared one salient common factor: brain surgery during adolescence.

Lead researcher Sebastian Brandner, a professor of neuropathology at University City London and his UCL team, hypothesized that the amyloid proteins may have been transferred into the patients’ brains during surgery by hitching a ride on surgical instruments that had not been cleaned well enough, New Scientist reported.

The theory is that medical instruments previously used on Alzheimer’s patients were then used on these young adults. If the tools were not properly cleaned, amyloid proteins from the Alzheimer’s patients could then be transferred to other patients operated on with the same tools.

Brandner told Newsweek that there are no other risk factors that can explain such early onset CAA, and this suggests that transfer of proteins via medical tools is likely why these patients developed the disease so young.

“Brain surgery is so far the most likely cause,” said Brandner. “In theory other routes are thinkable, but we have no evidence.”

This is not the first time researchers have proposed that brain proteins can be transferred from patient to patient via surgery. A 2015 study also led by Brandner also suggested that fragments of sticky amyloid proteins spread among patients through contaminated surgical tools, The Guardian reported.

Brain protein buildup in young people is rare but not completely unheard of. Another study from 2015 suggested that plaque buildup in young people could simply be a sign that the “resource” and “machinery” needed to make these protein clumps already exist in young people.

“The implication appears to be that if we want to prevent these clumps from forming when a person becomes old, we may need to intervene much earlier than we have thought, to try and get rid of amyloid very early in life,” the 2015 study co-author Changiz Geula, a professor at the Northwestern University Feinberg School of Medicine in Chicago who focuses on Alzheimer’s disease, told CBS News.