Anaheim, California — For years, nursing home clinicians treating tardive dyskinesia had to piece together a care approach on their own. There were no formal guidelines, no structured screening protocols, and no consensus on which treatments worked best in long-term care. A new expert panel just filled that gap.
A multidisciplinary Delphi panel, convened by Neurocrine Biosciences, has released what’s being called the first-ever expert consensus recommendations for screening, diagnosing, and treating tardive dyskinesia (TD) specifically in long-term care settings. The findings were presented at the Society for Post-Acute and Long-Term Care Medicine’s PALTC26 Annual Conference in Anaheim, California.
Tardive dyskinesia is an involuntary movement disorder caused primarily by long-term use of dopamine receptor blocking agents — the same class of drugs that includes many antipsychotics commonly prescribed in nursing homes. Residents are at heightened risk because of prolonged exposure to these medications, advanced age, polypharmacy, and complex health conditions. And the disorder is notoriously hard to catch: residents who are non-ambulatory, cognitively impaired, or unable to communicate symptoms can go undiagnosed for years.
“To date, there has been limited practical guidance tailored specifically to the screening, diagnosis and treatment of tardive dyskinesia in the long-term care setting,” said Dr. Sanjay Keswani, chief medical officer at Neurocrine Biosciences.
What the guidelines recommend
The panel’s recommendations center on a few core practices. First, facilities should use the Abnormal Involuntary Movement Scale (AIMS) as a standardized screening tool. Second, residents on dopamine receptor blocking agents should be screened quarterly — not just when symptoms emerge. Third, clinicians should regularly gather feedback on a resident’s well-being from family members, caregivers, and the broader care team, not just from the resident alone.
On the treatment side, the panel agreed that TD in long-term care settings should be treated with a vesicular monoamine transporter 2 (VMAT2) inhibitor. When selecting a specific therapy, they flagged several factors that matter most in this setting: formulation options for residents with swallowing difficulties, simplified dosing with no required titration, and careful attention to polypharmacy and drug interactions.
The recommendations come as the industry is already grappling with pressure over antipsychotic use in nursing homes. Regulators have been scrutinizing antipsychotic prescribing practices for years, and facilities that use these medications inappropriately risk survey deficiencies and public reporting penalties.
Clinical data backs the approach
The panel’s consensus was reinforced by new data from the KINECT-PRO study, which looked specifically at adults 65 and older treated with valbenazine — one of the VMAT2 inhibitors under review. Patients in that group showed meaningful improvements in TD symptoms, quality of life, and functional impairment at week 24. Patient-reported outcomes also showed reduced emotional and social burden.
For nursing home medical directors and directors of nursing, the practical takeaway is straightforward: quarterly AIMS screenings for any resident on dopamine blockers, a consistent team-based review process, and a clear treatment pathway once TD is identified. The panel’s guidance gives facilities a defensible, evidence-based framework that didn’t exist before.
Discover more from Skilled Care Journal
Subscribe to get the latest posts sent to your email.
