Medication for Behavior Is Last Resort With Elderly

Medication for Behavior Is Last Resort With Elderly
Dr. David Lipschitz
If you want to judge the quality of a nursing home, here is an insider's tip: Ask how many residents are treated with psychotropic agents, such as Haldol, Risperdal, Seroquel and Zyprexa. The fewer the better.

These psychotropic agents initially were developed to treat schizophrenia. They help prevent hallucinations, paranoid thoughts and delusional behavior. In nursing homes, psychotropic drugs are used to treat older patients with agitation, aggression, insomnia, wandering and other difficult-to-manage symptoms. These sedated patients are easier to manage and are not risks to themselves or others. As opposed to unsightly physical restraints, drugs serve as chemical restraints, putting patients in "zombielike" states.

While psychotropic drugs are appropriate treatments in certain circumstances, many nursing homes with inadequate or untrained staffs may use these chemical restraints simply to make their jobs easier. In the past year, numerous studies have shown that psychotropic agents are essentially of no value in managing most of the symptoms for which they are being used.

Staffs at good nursing homes do everything possible to reduce the number of residents receiving psychotropic drugs. A better-trained staff understands why and how a resident may become agitated, angry and difficult to manage. With a better understanding of patients' behavior, a well-qualified person can initiate changes to help ensure healthier experiences for residents and staff members.

For example, altering the way nursing home residents are spoken to and interacted with prevents irritation and aggression. In addition, sufficient close supervision can prevent wandering and reduce the risk of falling. Having beds close to the floor can reduce the risk of injury, as can novel alarm systems that allow the staff to become aware immediately when a resident is moving and at risk of falling out of bed.

Many nursing homes have moved toward using video systems to allow even closer monitoring of residents throughout the day. However, because of privacy concerns, this remains controversial.

Psychotropic medications are widely prescribed for patients with advanced Alzheimer's disease or other memory disorders because these patients tend to develop difficult-to-manage behavioral symptoms. In certain circumstances, hallucinations or delusions can occur; personality changes can lead to aggression and even physical abuse, marked paranoia and alterations of the sleep-wake cycle. It is not unusual for these patients to receive one or more psychotropic drugs, even when symptoms are minimal.

In addition to the sedative qualities of psychotropic drugs, the side effects can be substantial and dangerous. Symptoms of Parkinson's disease can occur, as can severe confusion, loss of appetite and dehydration.

A recent report in the journal The Lancet Neurology showed that psychotropic drugs doubled the risk of death in patients with Alzheimer's disease. All of these drugs now have a "black box" warning against prescriptions for older people with dementia because of the risk of death from cardiovascular disease or infections.

Sadly, despite side effects, the use of these drugs is often unavoidable. But they should be used only if frightening hallucinations, paranoia or delusions are present and only as a last resort, when all other options have been exhausted.

Psychotropic drugs never should be used to treat hallucinations if they are not frightening to a patient or others. There are other choices for those with agitation, sleep problems or disruptive and aggressive behavior.

If you have a family member who experiences any of these problems, consider the outstanding book written by Frank Broyles, the recently retired athletic director at the University of Arkansas at Fayetteville and a tireless advocate for more research and attention to Alzheimer's disease. His book, "Coach Broyles' Playbook for Alzheimer's Caregivers," is available for free at most drugstores. It provides sage advice on how to manage a loved one who has difficult-to-manage symptoms.

With appropriate training and care, a patient can be managed lovingly without medications. However, if you ever face the challenging task of choosing a nursing home, always ask for statistics on medication use. It can be a vital indicator of the staff's ability to find creative solutions to many of the challenging problems in long-term care.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

Copyright 2009 Creators Syndicate Inc.