Tough Questions about Medications for People with Dementia

Discussion with Doctor. Thomas Barwick/ Taxi/ Getty Images

Medications for people with dementia-- these can sometimes be a godsend, literally a life-saver for both the person with dementia and her family members. Psychotropic medications (a term for medicines that are prescribed to treat emotional and behavioral challenges) can address and reduce paranoia and anxiety, and they can treat and lessen the symptoms of depression.

However, medications always come with the potential for significant side effects.

Sometimes, those side effects are minimal- what's a little dry mouth?- but other times, those side effects are debilitating and also result in the prescription of more medications to address the side effects. And, too many medications can result in more confusion.

With the goal of looking at medication usage- specifically antipsychotic medications- objectively and without judgment, here's an example of a common scenario I encounter.

Challenges of a Dedicated Caregiver

A wife is caring for her husband at home, and is determined to continue to do so. She committed to loving her husband in sickness and health in their marriage vows, and she feels a strong desire and obligation to see this through at home for her husband. It's getting more and more difficult, however, to do this all by herself, especially as her husband's dementia is progressing and they're both getting older. She is doing everything she knows and giving everything she can.

She brings her husband to the doctor and mentions that he's not sleeping well, wanders periodically and is her constant shadow. The doctor notices that her health is starting to decline: her blood pressure is up, she's overly fatigued, and she's stressed out by caring for her husband 24 hours a day.

Does the doctor:

  • A) Order an antipsychotic medication [for example, Seroquel (quetiapine), Haldol (haloperidol), Zyprexa (olanzapine), Abilify( aripiprazole), or Risperdol (risperidone)] for her to give him to "take the edge off" when she needs to sleep?
  • B) Connect her with resources (such as the Alzheimer's Association or the Area Agency on Aging) to help provide care at home for her husband?
  • C) Suggest that she admit him into a nursing home before she's too sick to care for him?
  • D) Refer her to a support group?

In an effort to support the caregiver and ensure that the patient is not distressed, sometimes, option A is the only one that is chosen by the doctor. This is concerning because these medications, while appropriate for treating paranoia, delusions and hallucinations, are not intended to be prescribed for sleep or for easing a caregiver's job. They are necessary, helpful and appropriate at times, but not as frequently as they are prescribed.

Identifying the Reason for the Medication

I've spoken with family members many times when they are seeking to admit their loved one into a nursing care facility.

When I review the list of medications the person is taking and notice an antispychotic medication, I will ask what led to their family member receiving that medication. Many times, the answer is one of these: "I'm really not sure," or, "Oh, a few years ago she had some hallucinations when she was in the hospital and she's been on this ever since" or "He started to get a little restless at night so it was ordered for him so he could sleep better." According to the literature and guidelines, none of those reasons are appropriate justifications for an antipsychotic medication.

What if Medications Allow You to Keep Your Loved One at Home?

I fully understand and appreciate the desire to avoid a nursing home and care for the person at home. Although I have years of experience working in a nursing facility and can vouch for the love and excellent care that the residents receive, I realize that no one hopes to "end up" in a nursing home.

I would simply encourage family members be intentional on educating themselves regarding the medications their loved ones are receiving and the reason they're being prescribed, and ask that physicians partner in this process. When making decisions about the use of antipyschotic medication for someone with dementia, consider his quality of life; despite the best of intentions, it could be unintentionally negatively affected if those medications not being used appropriately and according to their intention.

DISCLAIMER

**Please note that the information included on this website and linked to both on and from this site is not medical advice and is for guidance and information only. I have made every effort to report information that is medically accurate and scientifically researched, but this is not a substitute for care and guidance from a physician.**

More Information about Medications

Should Your Loved One Really Be Receiving Antipsychotic Medication?

Can Too Many Medications Cause Symptoms of Dementia?

Medications for Emotional and Behavioral Symptoms of Dementia\

Non-Drug Approaches to Challenging Behaviors

Advocating for a Loved One with Dementia

Sources:

Michigan Department of Licensing and Regulatory Affairs. Behavior Management and Antipsychotic Medication Prescribing Clinical Process. August 18, 2003. http://www.michigan.gov/documents/mdch/bhs_CPG_Behavior_Mgmt_206257_7.pdf

Texas Department of Aging and Disability Services. Decreasing Inappropriate Use of Antipsychotic Medications in the Dementia Population. October 4, 2012. http://www.dads.state.tx.us/culturechange/training/antipsychoticmedications-10-12/decreasinginappropriatepresentation.html

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