Letters

Antipsychotics in nursing homes

The article “Antipsychotics overprescribed in nursing homes” (September, Monitor) discusses the horrifying reality of offlabel antipsychotic drug administration in nursing homes across the United States. While it is known that individuals in the later stages of Alzheimer’s, or other related dementia disorders, can experience symptoms of psychosis, it is staggering that 14 percent of the elderly in nursing homes are filing for Medicare reimbursement for antipsychotics. In an opinion piece on CNN, Daniel R. Levinson, inspector general in the Department of Health and Human Services, urged nursing homes, family members and pharmacies to pay attention to the “black box warning” on antipsychotic drugs, which warns of the death risk associated with elderly people with dementia.

Decline of cognitive abilities aside, one of the greatest challenges faced by both dementia patients and caregivers is the comorbid effects of psychosis. Management of these effects must include behavioral and pharmacological approaches. However, behavioral therapy, such as sensory intervention, environmental safety and maintenance of routines, is significantly underused in nursing homes. The article touches on the lack of proper education in behavioral therapy that nursing homes’ staff members possess, forcing them to use antipsychotics as a quick fix to calm their patients. Because of this, I implore better education of nursing home staff and family members of dementia patients.

Meghan Lee
Auburn University

Closing the achievement gap

In “Closing the achievement gap” in the September Monitor, Lea Winerman discusses a breakthrough 15-minute intervention that shows promising results for improving ethnic minorities’ academic achievement. While these early studies certainly raise the question of the need for replication with different populations, perhaps it would be more advantageous to understand why it works before proceeding to identify the areas where it works.

Future research should track specific mechanisms across the semester to look for predicting and moderating variables relating to academic achievement. Gaining a better understanding of the specific mechanisms the intervention changes (e.g., self-worth, anxiety, stress level, working memory capacity, etc.) would create a solid framework for new interventions to be built. Under this framework, existing interventions that treat the key mechanisms could be utilized (e.g., mindfulness-based stress reduction, which has led to increases in working memory and decreases in stress).

Having an assortment of effective interventions would allow teachers and educators greater flexibility. This would also help alleviate the common problem that occurs when students start predicting the purpose of the intervention.

Justin Puder
Auburn University


Please send letters to Sara Martin, Monitor  Editor. Letters should be no more than 250 words and may be edited for space and clarity.