Long-Term Care Survey Alert

Published on Fri Sep 26, 2008 PDF

Nursing home residents taking medications for dementia and incontinence may be at risk for accelerated ADL decline. That's according to a study conducted at Wake Forest University Medical School and published in a recent issue of the Journal of the American Geriatrics Society. Looking at MDS data, researchers found that residents in the top quartile of ADL function taking a cholinesterase inhibitor to slow dementia-related cognitive decline, and a bladder anticholinergic (oxybutynin or tolterodine) for incontinence declined 50 percent faster than those taking the dementia medication alone. The dual therapy didn't result in faster ADL decline for residents who started out with lower functioning, according to an online abstract of the study report. The combination of medications also didn't appear to decrease residents' mental functioning. But researchers surmise the MDS cognitive scale they used may not be sensitive enough to detect subtle changes in that regard. (Read the abstract at http://www3.interscience.wiley.com/journal/19387153/abstract.)

"It is likely that the oppositional effects of the drugs contributed to the accelerated decline," said Kaycee M. Sink, MD, MAS, lead author of the study, in a Wake Forest news release about the study. "Over a year's time, the decline we observed would represent a resident going from requiring only limited assistance in an activity to being completely dependent, or from requiring only supervision to requiring extensive assistance in an activity."

Wondering whether to do significant change in status assessments for residents entering hospice care? In a July 2008 RAI user's manual update, the Centers for Medicare & Medicaid Services clarifies that "while the need to complete an SCSA will depend upon the resident's status at the time of election of hospice care, and whether or not the resident's condition requires a new assessment, CMS encourages facilities to complete an SCSA due to the importance of ensuring that a coordinated plan of care between the hospice and nursing facility is put into place."

To review additional manual clarifications, download the update at http://www.cms.hhs.gov/NursingHomeQualityInits/Downloads/MDS20Update200807.pdf.