Antipsychotics

Our mom is in a nursing home with dementia.  She has been yelling and resisting care and the nursing home wants to start her on an antipsychotic.  I’ve heard these are bad drugs but what else can we do?

 

Up to 70% of nursing homes residents have dementia; most will become agitated and resist care at times.  Physicians around the world prescribe antipsychotics believing that’s the only option.

Medicare has become concerned because these drugs not only don’t work all that well, they can cause premature death, increase the risk of falling and strokes.  Therefore, State surveyors want to see documentation showing these drugs are used appropriately, which means only for schizophrenia, psychotic depression, or recurrent hallucinations and delusions.

I believe many demented patients are often agitated because they have pain, and either can’t or won’t tell us.  However, by watching face and body language, we can often recognize discomfort.  Starting with acetaminophen and, if that doesn’t help, increasing to low dose morphine, usually reduces the agitated behavior.

It’s important to use non-drug therapies, such as:  avoiding loud noise/music/TV (the music and TV needs to be geared to the elders—not for the caregivers); regular physical activity; scheduled bowel and bladder routines; pet visits; massage therapy; eating what they like (ice cream and chocolate !!--but avoid caffeine); and having calm caregivers who know how to redirect patient questions or behaviors.

Stopping as many drugs as possible definitely improves behaviors and reduces falls.  The fewer pills they take, the better they feel and behave.

There are many things we can do to help these seniors live more comfortably and not prolong their suffering; hospice can be a big help.