By Alex Threlfall, M.D.

Dr. Alex Threlfall is a board-certified geriatric psychiatrist and medical director for MarinHealth’s Older Adult and General Adult PHP/IOP. He is an associate clinical professor (volunteer) in the UCSF Family Medicine Department for the Sutter-Santa Rosa Community Health Family Medicine Residency and on the clinical faculty for the SRCH Advanced Practice Clinician fellowship. He also consults at AgeWell PACE — a PACE program for residents residing in Marin and Sonoma counties. Dr. Threlfall also serves on the board of directors for the American Association for Geriatric Psychiatry (AAGP) and serves as the AAGP Assembly member representative for the APA Assembly. He served as cochair/chair for the AAGP Public Policy Committee for nine years and was cochair of the Program Committee for the 2019 AAGP Annual Meeting. He completed his geriatric psychiatry fellowship at UCSF, psychiatry residency at the University of Pennsylvania, and medical school at Texas Tech University.

Working in advocacy has been a passion and integral part of my practice in psychiatry for nearly 20 years. From chief resident to a prolonged tenure as chair or cochair of the Public Policy Committee for the American Association for Geriatric Psychiatry (AAGP), there have been countless opportunities to advocate. One effort of which I am most proud is bringing attention to the discrimination of older adults living in nursing homes who are effectively stabilized on an antipsychotic for their behavioral and psychological symptoms of Alzheimer’s disease and related dementias or some other chronic mental health condition for which antipsychotics are appropriate.

In 2018, it was brought to our attention at the AAGP that the Centers for Medicare & Medicaid Services (CMS) was implementing a quality measure designed to severely restrict the use of antipsychotics in nursing home residents. This measure is a gross governmental overreach of controlling prescription practices in the halls of medicine and is at its core a discriminatory act toward some of our most vulnerable.

Working with the Alliance for Aging Research’s Project PAUSE (Psychoactive Appropriate Use for Safety and Effectiveness) and the American Society of Consultant Pharmacists, AAGP leadership aligned itself with CMS to develop a more appropriate measure for the CMS five-star rating algorithm. Unfortunately, despite years of in-person and virtual meetings, these efforts fell short, as the Sisyphean effects of blind bureaucracy won over.

Undaunted, we persevered. In 2023, I coauthored an APA action paper and American Medical Association (AMA) resolution to bring greater awareness to this mission and focus APA and AMA’s attention to correcting this wrong. We encourage all AAGP and APA members to speak with their local representatives to address this discriminatory behavior and publicly pronounce their experiences in local, regional, and national op-eds. It is our hope that sensible evidence-based science will win out, and patients will have access to the care they need.

In honor of Alzheimer’s Awareness Month this November, join APA’s Division of Diversity and Health Equity for our free webinar series, “Looking Beyond: Addressing Disparities in Alzheimer's Disease Research, Care and Diagnosis.”

Alzheimer’s Disease Across Populations: Gaps and Opportunities in Research

• Thursday, November 6, from 7 p.m. to 8 p.m. ET
• Zoom registration
• 1 CME credit

Meeting the Need: Alzheimer’s Disease in Rural America

• Wednesday, November 12, from noon to 1 p.m. ET
• Zoom registration
• 1 CME credit

Alzheimer’s Disease Biomarkers: A New Frontier, But Who Benefits?

• Tuesday, November 18, from 7 p.m. to 8 p.m. ET
• Zoom registration
• 1 CME credit