Drug-Managed Dementia Dilemma

Antipsychotics are meant primarily to help control hallucinations, delusions and other abnormal behavior in people suffering from schizophrenia and bipolar disorder, but they're also given to hundreds of thousands of elderly nursing home patients in the U.S. to pacify aggressive and paranoid behavior related to dementia.

Dementia and Alzheimer’s can prove to be huge challenges for the healthcare institutions we trust to care for our affected loved ones. Unfortunately, these are challenges many institutions meet with the over-use, abuse or improper use of drugs. The good news is that this problematic trend is being identified and resolved for many families.

As recently reported by the Associated Press, the turn to drugs for nursing home patients with dementia is nothing new. Dementia has a nasty tendency to disorient patients who may grow paranoid or lash out as a result. The safest way to protect them and others has been through medication to calm them. Of course, under-funded institutions also have a tendency to use drugs to a fault, and many use the wrong drugs, like antipsychotics. These drugs (like Risperdal, Zyprexa, Seroquel, Geodon, Abilify, Invega, and older medications) are designed to help people suffering from schizophrenia or bipolar disorder… and are not approved for dementia patients. 

I was personally involved in one spouse's nightmare recently when she had no alternative but to institutionalize her husband.  This particular institution chose to ignor the advise of the caregiver spouse who for five years had gently cajoled, jollied, distracted and generally humored her husband through 'sun-downer episodes in favor of placing him on Haldol and Depakote.  The likely cause of the aggressive behavior in his case was a urinary tract infection and not his Alzheimers.

Since 2005, these drugs have been under an FDA warning that they can cause an increased rate of death in dementia patients (due to heart attacks and pneumonia). Nevertheless, as of 2007 (according to a recently released government audit), about one in seven nursing home patients aged 65 or older was prescribed at least one of the drugs and, in about 83% of these cases, the prescription was for off-label use, like treating dementia. Ironically, the use of these drugs can create further confusion for the dementia patient and impair his or her ability to interact normally. Not surprisingly, many dementia patients actually have improved dispositions when they are taken off of these drugs.

It’s hard to estimate how widespread the problem is today, but at least it has been recognized and many institutions are correcting the trend. While the use of drugs is not bad in all cases (since there are patients who are severely disoriented), but certainly not every patient needs them or needs them at full strength. This is just one more concern to bear in mind when you visit your elderly loved one and when choosing the right nursing home for them.

You can learn more about elder law planning in the Elder Law Planning Practice Center on our website. Be sure to sign up for our free e-newsletter to stay abreast of issues like these that could affect you, your loved ones and your estate planning.

Reference: The Associated Press via ABC News (September 14, 2011) “Push Underway to Cut Drugs for Dementia Patients

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