Preventing Overuse of Medication to Control Resident's Behavior
Treating and managing difficult behaviors of patients with dementia is a regular issue for medical teams and care workers in residential homes. Some people become patients because their behaviors have led to admission. Sometimes they are admitted because their medical condition deteriorates. Other times difficult behaviors come about as a result of inadequate care management. If their behavior results in apparent over use of medication as a control agent, then family and friends who visit should act as advocate.
The caregiver has a pivotal role in making sure the drugs their relative is taking are doing a good job for the patient, rather than for the convenience of staff. If you suspect over-medication you shouldn’t automatically assume the worst. Sometimes it can take a little while to establish a therapeutic dose, so your feedback should be measured and constructive. Talk to the home manager about your observations and concerns in the first instance.
Signs of over-medication include:
- Increased confusion
- Reduced mobility and unsteadiness
- Shuffling gait
- Weight loss
- Reduced communication, mumbling, incoherent speech, increased incidence of urinary and fecal incontinence. In very severe cases the tranquilizing effects of medication can lead to depression of respiration and heart rhythm abnormalities.
Older people are often taking medications for existing medical problems such as high blood pressure, chronic cardiac conditions, arthritis or other forms of chronic pain. If further medication is added to the mix, for example in an attempt to control aggression or violence, the overall effect could lead to major health problems unless the patient is very carefully observed.
The benefit of reducing the medication burden can be considerable for people with moderate dementia. Taking six or more drugs is associated with a major risk of delirium development. Taking four medications or more is associated with a higher risk of falls.