Breaking New Ground On Safe and Effective Reductions in Medication Use
Breaking New Ground On Safe and Effective Reductions in Medication Use
Each year, millions of people in this country are helped by psychotropic medications—drugs that affect the mind, emotions, and behavior and that can play an important positive role in regulating mental health. These medications can be life-changing. They also carry serious risks and dangerous consequences, particularly for older adults.
Despite their potential danger, psychotropic drugs (including a class known as anti-psychotics) are often prescribed for older adults, including those residing in long-term care facilities and especially those with dementia. Government and other health regulators require nursing homes to report data on the number of residents they serve that are on anti-psychotics, and the numbers in many facilities across the county show widespread use.
An important initiative at Los Angeles Jewish Health is addressing this issue head-on and is implementing innovative ways to reduce seniors on psychotropic drugs while improving their overall health. Thanks to a close collaboration between doctors with expertise in geriatrics, nurses, pharmacists, and social workers at LAJH, residents are increasingly showing dramatic health improvements—and even thriving—without these risky medications.
“The use of antipsychotic medications in nursing homes in the U.S. is a significant problem,” says Noah Marco, MD, CMD, LAJH’s chief medical officer. “For residents with dementia, the instinct to prescribe the drugs is perhaps understandable: They often exhibit behaviors that are difficult to manage with non-medication treatments, a challenge complicated by the lack of FDA- and insurance-approved medications for the agitation caused by Alzheimer’s dementia.”
To address this challenge, LAJH has created a new process, bringing an interdisciplinary team together on a monthly basis to review the cases of residents who are on psychotropics and to identify safe and effective ways to reduce or eliminate the use of the drugs for those individuals. The protocol is yielding impressive results.
“Thanks to the dedicated and compassionate clinicians and staff at LAJH, we’ve achieved a 49% reduction of anti-psychotic medication use from the fourth quarter of 2023 to the second quarter of 2025,” Dr. Marco says. “The new numbers put us well below the state average for usage rates—and we accomplished this without increasing prescriptions of other psychotropic medications.”
The LAJH teams’ strategy has been driven by a focus on seeking alternate treatments tailored to the individual needs of each specific resident.
“We’re working to put gradual dose reductions in place, prioritizing non-pharmacological interventions to support residents’ wellbeing instead of medications,” says Ilana Springer, LAJH’s senior vice president of In-Residence Services. “Often, that translates to learning what kind of activities might prove triggering to a resident and then finding other, more soothing activities to help them feel better.”
According to Aida Oganesyan, director of the LAJH pharmacy, this kind of customized care has been critical to the new initiative’s success.
“We reduce anti-psychotic medications on a case-by-case basis—and we only do it in concert with providing substantial support for each resident,” Aida says. “By being extremely measured in our approach and providing patient-centered care, we ensure that we’re only tapering residents from these drugs when they truly don’t need them.”
Of course, this level of individualized care comes at a cost—one that is made manageable thanks to support from LAJH’s generous donor community.
“We could not be doing this without help from our donors, whose contributions allow us to have a higher nurse-to-resident ratio than many nursing homes,” Dr. Marco says. “The additional staff—as well as the many volunteers, residents’ paid companions, and family members who sit with our dementia residents and keep them safe and calm—are far more effective than any medication.”