Experts: Avoid Use of Antipsychotics with Alzheimer's Patients
I saw my mother due some really weird things after she was diagnosed with Alzheimer’s disease. I saw her get extremely agitated for no apparent reason. I also saw her try to get into a physical fight with another nursing home resident. And I saw her think she was in an airport concourse madly worried that she was going to miss a flight when she was actually sitting in a wheelchair by the nursing station.
All of these events were difficult to get my head around – that’s not what Mom would do in her normal state of mind – and even more challenging to determine how to handle. Should I ask the nursing home to give her antipsychotic medications? Or should I find a way to calm her behavior? As someone who is not too enamored with taking lots of medications, I always chose the second option. And it turns out I was right.
More and more, policy groups and health care professionals are discouraging the use of these types of medications. For instance, the American Geriatrics Society encourages doctors, patients and caregivers to avoid using antipsychotics as the first choice when treating behavioral and psychological symptoms caused by dementia. These symptoms can include aggression, resistance to care and disruptive behaviors.
Pointing to the limited benefits of these medications, the organization warned that these drugs also can cause serious harm, including stroke and premature death. “Use of these drugs should be limited to cases where non-pharmacologic measures have failed and patients pose an imminent threat to themselves or others,” AGS stated. “Identifying and addressing causes of behavior change can make drug treatment unnecessary.”
Yet, it turns out that these drugs are used more often than this group would wish. In a 2012 guest blog on Mayo Clinic’s website, Dr. Cheryl Phillips, a geriatrician, points out that approximately 40 percent of people with dementia who live in nursing homes receive these types of medications. Furthermore almost 15 percent of all nursing home patients are prescribed antipsychotics.
Dr. Phillips points out that these drugs have not received approval by the Food and Drug Admnisteration for use in treating dementia. Furthermore, no more than 30 percent of elderly dementia patients who take these medications show marginal improvement. However, one in every 54 patients will die from being treated with antipsychotics. Also, one patient will die for every nine to 25 patients with dementia who benefit from these medications. She points out that the FDA has given antipsychotics a rare “black Box Warning” because patients who are given these drugs face a risk of death that is 1.6 to 1.7 times higher than patients who have been given a placebo. Instead, Dr. Phillips suggests that caregivers and health care staff should realize that the person with dementia is trying to communicate something during these episodes.
So what would should you do in these situations? The Alzheimer’s Association recommends the following:
- Plan routine activities.
- If the person is upset, separate him or her from what is causing the irritation.
- Check to see if the behavior might be caused by pain, constipation or other physical problem.
- Review whether medications may be causing the behavior. This especially may be true with new medications.
- If the loved one is acting like they are in a different time act like you’re with them there.
- Respect the loved one’s thoughts, even if they are incorrect, and don’t disagree with them or her.
- Watch your physical interaction. Be sure to maintain eye contact, give the person with dementia space and get to their level (such as sitting if they are sitting).
- Speak calmly and slowly; maintain a normal tone of voice since the person with dementia may pick up and respond to that even if they do not understand the words that you’re speaking.
- Do not scold, threaten or point your finger at the person.
- Redirect the person’s attention to an enjoyable activity or a food that he or she likes.
- If you’re the cause of the person’s distress, leave the room for a while.
- Reassure the loved one that you want to help, that you love him or her and that you understand that he or she is upset about something.
- Do not ask the person to do any actions that in the past have caused them to become agitated or aggressive.
Primary Sources for This Sharepost:
Alzheimer’s Association. (2011). Challenging behaviors.
American Geriatrics Society. (nd). Five things physicians and patients should question.
Lunde, A. (2012). Antipsychotics overused in people with Alzheimer’s. Mayo Clinic.