Antipsychotics in Dementia: Considerations for Caregivers

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Antipsychotics are a classification of drugs that are often prescribed to treat the behaviors associated with dementia.  The potential for serious side effects needs to weighed against the benefits and monitored closely.

People with dementia often exhibit psychological symptoms which make managing their behavior difficult. Caregivers of people with dementia, especially later-stage dementia, may be familiar with symptoms such as hallucinations, delusions, paranoia, and aggressive behavior. Clearly, such behaviors carry some danger to the dementia patients and others. Caring for a senior with dementia is hard under any circumstances, but severely aggressive or psychotic behaviors can cause concern for caregivers, professional and non-professional alike.

The question of whether or not someone with dementia should be prescribed antipsychotic medication should be examined thoroughly. There are some serious drawbacks to medications used to treat dementia.

 

Dangerous Antipsychotics with Dementia

Antipsychotic medications are often used to treat dementia patients. Yet these drugs may have serious consequences for patients with dementia. The Alzheimer’s Society of Great Britain points to studies that show that the use of antipsychotic drugs to treat behavioral and psychological symptoms of dementia increases the risk of stroke by nine times in the first four weeks of use. The risk of death can double.

Antipsychotic medication contributes to 1,800 deaths a year, a startling statistic in the caregiving community. It can also cause cardiovascular complications. According to research from the University of Michigan, risks increase as the dosage increases. A low initial dosage that causes no problems may become harmful if more is prescribed. Because of this risk, every effort to address these issues should be made before any medications are given. All other options should be exhausted before taking such a chance with the life of an elderly person.

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Limited Benefits

Antipsychotics are only marginally effective at treating dementia behaviors and thus might not be worth the risk. Since the demented brain is under severe stress and undergoing constant deterioration, these drugs may not eliminate dangerous aggressive behaviors. If the senior, the caregiver, and the doctors all agree that an antipsychotic is appropriate, the effectiveness of the medication should be evaluated frequently to weigh the benefits against the risks.

 

What This Means for Caregivers

Caregivers should advocate for better care for seniors. They should insist that care providers have the time and training to give excellent care. Staff members in long-term care facilities often know that taking plenty of social time to get to know residents and their needs result in superior care. They know that dealing with episodes of confusion or agitation sensitively yields optimal results.

Policies and procedures often get in the way of optimal care. Caregivers should take their concerns to higher levels of administration, or even lobby for better pay or stronger regulations. This can help make long-term care better and safer for seniors with dementia. Caregivers can also seek avenues for increasing the amount of time doctors see and examine their patients. They can advocate for cheaper care for seniors, who often cannot afford all the healthcare they need. Patients who are ill or in pain, on top of having dementia, can often exhibit more aggressive symptoms. More thorough and accessible care can prevent these types of incidents.

 

Due Diligence

Family members should be thorough in their investigations of policies and procedures in long-term care facilities and/or adult day care centers when it comes to their elderly loved ones. Recent studies show high numbers of adults with dementia (as many as 33%) are taking antipsychotics in nursing homes. This is increasing their risks of life-threatening illnesses and side effects. Before allowing an elderly loved one to enter any facility, family members should ask direct questions. How and when the facility prescribes and implements antipsychotic medication is an appropriate question. Also, caregivers should ask how the facility deals with delusions and hallucinations as well as aggressive behavior.

Supportive physicians will only prescribe antipsychotics if absolutely necessary. More and more research is emerging which points to thousands of unnecessary prescriptions for these drugs. If physicians or facility staff advocate these drugs, family members should ask why. They should be concerned and seek a second and even a third opinion.

 

Alternative Treatment Options

There are alternative treatments for dangerous behaviors on the parts of dementia patients. Identifying and avoiding triggers for aggressive behavior is important. A counselor, therapist, or psychiatrist can help, especially one trained to address the needs of older people with dementia. Caregivers can make plans to de-stress before, during, and after potentially triggering events. These events include moving, taking a trip, or even going to the doctor.  If a caregiver can prevent these episodes, he or she can eliminate the need for medical intervention. In addition to prevention, the responses of caregivers are key. Remaining calm and behaving in unthreatening and open ways is important. Listening carefully to the concerns of someone with dementia who is behaving aggressively is also important. All of these techniques can help resolve many conflicts which, if responded to otherwise, could escalate aggressive behavior dangerously.

 

Sources

Alzheimer’s Society. Antipsychotic drugs. Available at https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=548. Retrieved June 13, 2016.

Alzheimer’s Society. Treating behavioral and psychological symptoms of dementia. Available at https://www.alzheimers.org.uk/info/20162/drugs/106/drugs_used_to_relieve_behavioral_and_psychological_symptoms/2. Retrieved June 13, 2016.

Government Accountability Office (GAO). (January 30, 2015). Antipsychotic drug use: HHS Has Initiatives to Reduce Use among Older Adults in Nursing Homes, but Should Expand Efforts to Other Settings. Gao.gov. Available at http://www.gao.gov/products/GAO-15-211. Retrieved June 13, 2016.

Gavin, Kara. (March 18, 2015). Are antipsychotic drugs more dangerous to dementia patients than we think? Mhealth System. University of Michigan. Available at http://www.uofmhealth.org/news/archive/201503/are-antipsychotic-drugs-more-dangerous-dementia-patients-we. Retrieved June 13, 2016.

Maust, Donovan, Hyungjin Myra Kim, Lisa Seyfried, Claire Chiang, Janet Kavanaugh, Lon Schneider, and Helen Kales. (2015). Antipsychotics, Other Psychotropics, and the Risk of Death in Patients with Dementia. JAMA Psychiatry, 72(5): 438-445. Available at http://archpsyc.jamanetwork.com/article.aspx?articleid=2203833. Retrieved June 13, 2016.

Steinberg, Mark and Lyketsos, Constantine. (September 2012). Atypical antipsychotic use in patients with dementia: managing safety concerns. American Journal of Psychiatry, 169(9): 900-906. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516138/. Retrieved June 13, 2016.

University of Iowa. Managing a Crisis. Iowa Geriatric Education Center. Available at https://www.healthcare.uiowa.edu/IGEC/IAAdapt/view/Managing_a_Crisis_consumers.pdf. Retrieved June 13, 2016.

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