
I remember graduating as an LPN, thinking I could conquer the world. That was a long time ago, and while I still have fleeting moments of infallibility, I’m definitely a lot wiser! I recall walking onto the skilled nursing unit for the first time, responsible for 32 residents—yikes! Back then, residents were low acuity with high supportive needs, and many were on antipsychotic medications to “manage their behaviors,” with some even exhibiting symptoms of tardive dyskinesia and antipsychotic use in senior living.
Little did I know at the time that although we were “doing what everyone else was doing,” we were likely causing irreversible conditions. The risk/benefit idea was relatively new back then. Fast forward to today—antipsychotics are not the treatment of choice, thank goodness! Today, we have effective behavior management programs and therapeutic activities that maintain a healthier environment. However, some facts about tardive dyskinesia and antipsychotic use in senior living may surprise you:
- Any resident on a dopamine receptor-blocking medication is at risk for TD
- Antiemetic medications used for nausea/vomiting are included
- Second-generation (atypical) antipsychotics (advertised on media sources daily)
- People over age 40 have a higher risk of developing TD
- Females tend to develop TD at higher rates
- Post-menopausal women can have rates as high as 30% after 1 year of antipsychotic use
- African Americans are more likely to develop TD after long-term exposure
There is some good news—there are new medications that may decrease the symptoms of TD, and Vitamin E might protect against worsening. Also, first-generation antipsychotics carry about 10 times the risk of TD compared to second-generation drugs, though second-generation drugs may increase the risk of unwanted weight gain. However you look at it, you should be reviewing your pharmacy reports, talking to your medical director, having an actionable, proactive antipsychotic reduction program, and assessing for signs and symptoms of TD. Stay well and stay informed!
To learn more about Tardive Dyskinesia, Verywell Health has an excellent article discussing the early signs of TD, Early Signs of Tardive Dyskinesia (verywellhealth.com)