Families and healthcare professionals question medication use for people diagnosed with Alzheimer’s disease or a dementia, especially due to the media coverage about the overutilization and potential dangers of antipsychotics and other medications.
It is important to investigate potential causes of symptoms or behaviors and identify what can be done before resorting to medication. Sometimes the person’s behavior, agitation, anxiety is due to unexpressed physical needs, perhaps they are in pain, have an infection, are tired, hot or cold, or distressed by an over stimulating environment or demanding caregiver.
I have worked with Robert Cluxton, Pharm.D., Professor at the University of Cincinnati College of Pharmacy for twenty-five years. Without going into great detail, we share decades of experience and some views on medication for distressed individuals with cognitive impairment.
- Not all medication is bad: Often anxiety and aggression are expressions of depression because their world seems out of control. If a person is depressed, an antidepressant can be helpful and improve quality of life for the individual (and caregiver).
- Anxiety: It is agonizing when an individual with dementia is upset most of the time and for the caregiver as well. A low dose of medication may ease their anxiety and make life better for all.
- All behavior is about something: identifying a cause, understanding what that “something” is remains the problem, and if you can’t identify a reason for uncontrollable agitation or rage – should they continue to suffer?
- Sedation: Medications to reduce restlessness and anxiety often causes sedation initially. Giving the medication consistently results in stabilization in time, when the periods of sedation and anxiety dissipate – usually about 3 to 4 weeks. Too often medication is started then stopped due to sedation. Taking a person on and off a medication is problematic for the individual, and the targeted symptoms are not addressed.
- Consistency versus “as needed:” Certain medications must be given routinely for optimum results. If an antianxiety medicine is prescribed for someone who is frequently anxious, especially in the evening, it may be best to prescribe a routine dose throughout the day and evening. Medications prescribed “as needed” are often given too late to be effective.
- Stay the course: Some medications take time to build up to certain levels in the body before they are effective. For instance, you may not see results from many antidepressants or similar medications for 4-6 weeks. While it is not easy, the benefits are often worth the wait.
- Medications need not be given forever: Starting a medication does not mean it needs to be taken indefinitely. As an individual moves through the dementia disease process, the need for medications will change. Ongoing routine evaluation is needed to determine if any medications need to be reduced or discontinued. This will help ensure all medications continue to be needed and are at the lowest effective dose.
- Pain: People with dementia do have pain. It is reasonable to expect pain if they have a history of arthritis or have surgery or dental work done. We should anticipate they are in pain even if they are unable to verbalize. Assume and treat pain as you would for any person.
Caregiving is difficult for both families and healthcare professionals. Medication can be beneficial and should be considered when appropriate. Yes, we must weigh the benefits versus risks, but important too is that we consider the quality of life and comfort for each individual with dementia and what is in their best interest.