Assessment Tools for Movement Disorders are Accessible Online
Elderly patients receiving pharmacologic therapy for psychiatric and neurologic diseases sometimes experience drug-induced movement disorders, which negatively impact their quality of life and also increase their likelihood of medication noncompliance. Frequent use of various assessment and screening tools can help clinicians, pharmacists, and other healthcare providers identify drug-induced movement disorders, facilitating earlier management. What follows are some examples of commonly used scales that are easy to administer and assist in the clinical assessment of the four major classifications of movement disorders:
Pseudoparkinsonism. This disorder is characterized by slow, rigid, and stiff movements, and is commonly seen in women older than 65 years, those with hyperthyroidism, and those with a family history of Parkinson’s disease.
• Simpson-Angus Neurologic Scale (SANS): While the patient walks at a normal rhythm (approximately 15 paces), the clinician rates 10 items that indicate the patient’s degree of rigidity, including gait, arm dropping, and shoulder shaking. The SANS can be downloaded here.
Dystonia. This disorder is characterized by sustained muscle contractions and contortion, usually in a repetitive and twisting manner. Although commonly seen in younger men, it has been observed in elders. Intramuscular and intravenous administration of agents, particularly those with high potency, is a known risk factor of dystonia.
• Fahn-Marsden Dystonia Rating Scale: This two-part test includes a movement scale based on motor features of dystonia and a disability scale based on patients’ subjective impairments in activities of daily living. Both parts of this test and other dystonia rating scales can be accessed here.
Akathisia. This disorder, which is characterized by subjective feelings of motor restlessness, is commonly seen in those being treated with newer antipsychotic agents.
• Barnes Akathisia Rating Scale (BARS): This scale involves observing patients for fidgety or restless movements while they are in seated and standing positions in 2-minute increments, and asking them to rate their awareness of restless behavior and their level of distress. The BARS can be downloaded here.
Tardive dyskinesia. This disorder is characterized by oral and facial abnormalities, such as grimacing and lip smacking, and is commonly encountered in older, postmenopausal women on high doses of antipsychotics or who have been on these agents for a long time.
• Dyskinesia Identification System and Condensed User Scale (DISCUS): This 15-item tool measures seven regions and assesses the severity of dyskinesia based on the frequency, quality, and amplification of movement. DISCUS can be accessed here.
• Abnormal Involuntary Movement Scale (AIMS): This 12-item scale also rates the severity of orofacial, extremity, and trunk movements; however, the guidelines for scoring have not been well defined. AIMS can be downloaded here.
Medicare Announces Additions to Tool for Comparing Nursing Homes
On July 19, 2012, the Centers for Medicare & Medicaid Services (CMS) announced that the Nursing Home Compare website has been updated and redesigned. CMS created Nursing Home Compare in 1998 as an interactive tool for Medicare beneficiaries and their caregivers to access comparison information about every Medicare- and Medicaid-certified nursing home in the country. The website compares nursing homes according to quality measures of the health, physical functioning, mental status, and general well-being of short-stay and long-stay residents. This information is collected and self-reported to CMS by nursing homes using a form called the Minimum Data Set.
Additions to the Nursing Home Compare website include access to narratives that outline specific findings from nursing home inspections, as well as two new quality measures that report on a nursing home’s use of antipsychotic medications. Data on the other quality measures and information on nursing home ownership have also been updated.
“These new updates to the Hospital and the Nursing Home Compare websites are the next stage of transparently sharing data to drive improvement in our health system,” said Patrick Conway, chief medical officer for CMS, in a press release. Other elements of the redesign include large maps for pinpointing facilities, glossaries, and other tools to make the website easier to search and understand.
Improvements to the Nursing Home Compare website were expressed as a goal in the CMS 2012 Nursing Home Action Plan, a strategic plan published earlier this year that outlines goals in improving nursing home quality nationwide. The recent changes to the website were spurred by feedback from consumers, healthcare providers, state representatives, and other groups, with whom CMS representatives met during early summer. According to the Action Plan, CMS will continually evaluate additional quality measures for nursing homes, such as measures of hospitalization, discharge to the community, and functional status improvement in both short-stay and long-stay residents. Read the entire 2012 Nursing Home Action Plan.