I'm hearing, as a columnist, more questions about the use of medications to "calm" dementia patients. The Wall Street Journal recently ran an article titled Nursing ...
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Here, take this pill. It's good for me, or you, or us.
Richard Taylor
Saturday, January 05, 2008 at 02:26 PMre: Here, take this pill. It's good for me, or you, or us.
Carol Bradley Bursack
Saturday, January 05, 2008 at 03:21 PMWell said, Richard. Personal attention as to why the person is agitated, or whatever they want to call it, is generally much more effective. It's been shown that when medical people take time to talk to the people and find out what is frightening or upsetting, the person can settle down without drugs. As this article said, these drugs are far too often used for the convenience of the nursing home than for the sake of the patient. Attention - personal one on one attention - should be the first choice. Seeing my dad on Haldol was awful, and it took a real battle, but we got him off and he was much better.
I'm so honored when you respond. Thank you for all you do.
Carol
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balance
ninamarczynski
Tuesday, March 11, 2008 at 10:24 AMIt is right that the patient's right comes first. But at times if the patient can hurt the caregivers, then a solution is needed for the balance. Not drugs but some other alternatives or ways to cope. Like my home care nurse said, she cannot allow her caregivers abused physically in case my father-in-law gets violent some day. At that time, a skilled nursing home is needed. Still I believe we do have to accomodate the patient when it is possible.
Nina
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Carol Bradley Bursack
Tuesday, March 11, 2008 at 10:45 AMThat's true. There's always such a fine balance. No one should be abused physically or mentally, whether the caregiver or the recipient. But, with dementia, it's even harder to know when to draw the line. I'm glad your caregiving help is up on what to do.
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nancy alling
Sunday, August 17, 2008 at 02:10 PMas the adult child of a parent with dementia who is iving in a nursing home how can I impact (reduce) the nursing home's reliance on antipsychotic medication. My 91 yr old mother is currently given ativan any time she becomes anxious or paranoid - the nursing home's goal is to put her on respirdol. I am opposed to this course of action. I have found that my mother does not experience these episodes when she is with people and engaged. Is there research or examples of nursing homes in the USA that are models for dealing with confusion and anxiety without medication?
Thank you for your help
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Carol Bradley Bursack
Sunday, August 17, 2008 at 02:45 PMThe Pioneer Network is a group of people working to totally change this attitude, but it's a long road. Some states have tougher laws about medicating, but I know just what you are talking about. Can you get your mother to a different psychiatrist? I know it's hard once they are in a care center that uses one hospital or clinic.
Antipsychotics are far too often used as restraints, when human connection is what is really needed. One friend on mine switched nursing homes for his dad, as he felt the one his dad was in over-medicated rather than giving the attention needed. Do you have many choices in your area?
You could check with your state human services and they could direct you as to state control of such issues. Good luck with this. The drugs can be good, when properly used for anxiety, but when used instead of human connection, they are bad. Your mother is lucky to have you for an advocate.
Carol
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When some one with dementia becomes "agitated" whose problem is this? Do agitated people come up to nurses and ask to be sedated? Do caregivers calmly watch agitated family members knowing that agitation is many times a symptom of the disease?
"Acting out, agitation" or whatever word IBM's (people without a cognative disease) label unwanted behaviors of Apples (people with a cognative disease) produces the same feelings in IBM's as their labeling of us walking around as "wandering." They have to do something about it, no matter what the cost to us. They don't like watching us being agitated. Better we were delusional between our ears, paranoid, sleeping, zonked out, than agitated.
I'm not advocating letting us folks with dementia hurt ourselves as a direct result of transitory agitation, but shouldn't the IBM's of the world consider the consequences of meeting their needs on us? Shouln't we be given the benefit of our doubts, of their doubts?
What about the chances of becoming dependent on these drugs to maintain a state which I don't want to be in, but you have decided it's better for me to live in the drug than in the world? Would I really chose to live "under the influence" the rest of my life? Nightmares, halucinations, fear upon fear upon fear, paranoid of everyone and everything, seeing the world through a gauze, no hope of self awareness - are these better states of mind than being agitated?
Are drugs what are best for us? or for others? Sometimes its a close call, sometimes it isn't. Unfortunately for us we are not always in a position to represent our rights to live a drug free life, free of side effcts, free of sacrificing our own state of mind to calm the state of minds of others. These decisions need more consideration than saying over the phone, go ahead and sedate him, go ahead and give him as much antipsychotic drug(s) as are necessary to calm him to meet your needs.
And why don't we talk more about these issues with you and others when we aren't agitated? Why don't you ask me to describle in detail what happends to me when drugs are forced on me to "calm" me.
It's certainly worth an occasional coversation among yourselves and with me.
Richard
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