Neurology Education

In this episode, Lauren Gerlach and Matt Davis speak with Theresa Shireman, PhD, Director of the Center for Gerontology and Healthcare Research and a Professor of Health Services, Policy and Practice and Epidemiology at the Brown University School of Public Health. Dr. Shireman’s research focuses on pharmaceutical policy, pharmacoepidemiology, health services research, and medication use among vulnerable populations. Dr. Shireman discusses her recent study, "Impact of Federal Antipsychotic Use Policy in Nursing Homes on New Diagnoses for Approved Indications in Dementia Residents," published in the Journal of the American Geriatrics Society. The study examines whether federal policies designed to reduce antipsychotic use in nursing homes were associated with increases in new diagnoses of conditions, such as schizophrenia, that exclude residents from publicly report antipsychotic quality measures. Using an interrupted time-series design, the researchers examined changes following the 2012 National Partnership to Improve Dementia Care and the 2015 addition of antipsychotic use to the Nursing home Five-Star Quality Rating System. They found that neither policy was associated with an increase in new exclusionary diagnossees, challenging concerns that nursing homes were increasingly assigning these diagnoses to circumvent restrictions on antipsychotic use. The conversation also explores the benefits and risks of antipsychotic medications for people living with dementia, including the potential for serious adverse effects such as sedation, falls, stroke, and increased mortality. Dr. Shireman discusses how public reporting and financial incentives can influence prescribing practices,the limitations of using a single quality measure to evaluate nursing home care, and the importance of balancing medication safety and residents’ individual needs. The discussion highlights the need for shared decision-making among clinicians, nursing home staff, residents, and families, as well as greater investment in staffing, resources, and nonpharmacological approaches to improve quality of life for people living with dementia. The transcript for this episode can be found here.

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