It is estimated that in many residential elderly care homes as many as 80% of alzheimers residents are prescribed antipsychotic drugs. Authorized use for antipsychotics are for diseases such as bi-polar and schizophrenia mental illness. The delusional, aggressive and psychotic behavior often exhibited by alzheimers victims appears the same on the surface, yet alzheimers is chemically and pathologically unlike mental illness. Therefore prescribing anti psychotic drugs to people with AD, makes little sense.
“Yet drug companies claim studies have shown an improvement of 28 to 40% when prescribing antipsychotics to the elderly. A casual look at their studies reveal:
- Virtually all studies have been conducted by the manufacturers of the drugs.
- And secondly sedation is often considered an improvement. Sedation is not resting peacefully from exhaustion. In a nursing home, sedation looks like “is there any one there”, it looks like no appetite, gait imbalance, drooling, dehydration and it smells like incontinence.
Even The New England Journal of Medicine concluded that in the case of anti psychotic drugs the risks out weighed the benefits for behavioral symptoms of dementia, including residents with delusion and aggression. Many who care for people with dementia will tell you that antipsychotic medication may reduce episodes of agitation or aggression but the result is rarely an alert, engaging, relaxed individual. Many of us who have placed our love ones in a residential home know only too well that if the resident can not be controlled, they the are at risk of being shipped to another type of home. That is why we surrender to the nursing home “suggestion” that we get your loved one on an antipsychotic. Within weeks of my mom and dad going in a nursing home, the administrator strongly “suggested” anti psychotics for both mom and dad. I finally capitulating (only for my mom) as I feared her new delusional behavior might get her kicked out. The next few weeks I saw my moms reality turn into the sedated resident described above. It took me three more weeks to get my mom off risperdone. As I expected, the administrator fought me hard, claiming if we “up” the dose she would get better. I did not buy it. I prevailed and within weeks my mom settled down to her new environment. My moms delusional paranoia behavior ended. She was often still inappropriate, sporadically agitated and generally a big pain in the ass. However that was considered an improvement and she was not at risk of being moved to a behavioral facility.
Congress heard hearings last week about the over use of antipsychotic drugs in nursing home, particularly with dementia.The Special Committee on Aging examined the widespread use of these drugs among dementia sufferers. Their main issue was the cost of the improperly prescribed antipsychotics to taxpayers. US senator Herb Kohl, Chairman of Special Committe on Aging, stated “we have a responsibility to taxpayers to be certain that they are not paying for drugs that are not needed.” Inspector General of the Department of Health and Human Services, Daniel Levinson, said that, claims totaling almost $116 million did not meet Medicare coverage requirements for medically accepted indication.” That was just for six months! He went on to release a report on the overuse of antipsychotic drugs which said the two main problems are “overmedication and Medicare pays for drugs it shouldn’t.” Dr. Jonathan Evans with the American Medical Directors Association said the drugs are used “as chemical restraints.” adding, “In fact, few physicians practicing in this country today received any meaningful training in nursing homes and other long-term care settings during medical school or residency training.
Eden Alternative Elder Care is a pioneering philosophy that seeks to minimize the use of drugs in an elder care facility. Their essential goal is to find an approach that helps eliminate the vast majority of behavioral aggressions. Mandatory staff training includes building a dedication to eliminating the plagues of loneliness, helplessness, and boredom that make life intolerable in most of today’s long-term care facilities. An unrelated study published last week demonstrated that this same impassioned focus of connection (often one on one) intervention proved more effective than medications in slowing progression of alzheimers. The system consists of motor stimulation, including games and balancing exercises; cognitive stimulation such as puzzles, and practicing ‘daily living’ activities, including preparing snacks, gardening and adding a spiritual element from songs and hymns. It turns out the same approach that encourages positive behavior, also maintains cognitive ability.
I believe my dad is now in one of the best residential care facilities in the country. With the upmost respect, I advocate for my dad regularly. The remarkable staff has embraced my interaction. Without any drugs my dad is content, engaged, alert, participatory and shows a respect and pride in his home. For some reason he feels much more independent now that he is not living with me. This is the home where my mom and dad were together for a few months before she passed, after both had lived with me. It is the same home, the same staff with the same administrator as I once disagreed with. They have not changed. They were always a great home.
Adapted from Physical Activity Postpones Dementia
Power,Allen,MD.(2010), Dementia Beyond Drugs;Changing the Culture of Care,Health Professional Press.