Medication use in the individual with dementia associated behaviors is a hot topic in the professional and public media. It is worthwhile to take the time to discuss the risks and benefits and issues related to the use of this class of medications.
Medications that impact the brain and its function are called psychotropic medications. Not all medications can cross the barrier that the brain has to protect itself. These medications can cross the blood brain barrier, or they would not be effective. As with all medications, they are chemicals that are externally introduced and have symptoms that impact not only the brain but other body systems as well.
For instance, if you take an antihistamine for allergies, you will have some drowsiness. If you take blood pressure medications, you may have impotence. If you take aspirin, you can have bleeding in your stomach. Too much Tylenol can cause liver failure.
Medications called atypical psychotropics are most often used when behaviors associated with dementia lead to potential harm for the person with dementia or their caregivers. The Centers for Medicare and Medicaid have made it a priority to decrease the use of these medications in nursing facilities; however, there are times that regardless of how many environmental and conservative approaches that are used the senior continues to have these harmful behaviors. When other potentially beneficial interventions have been attempted, it may be time to speak to a geriatric psychiatrist about the use of these medications.
These medications are not without side effects. Studies have demonstrated an increase in potential for death of 1.5 to 1.7. Weighing the risks of death from the medication against the benefit of psychological pain and behaviors from the dementia are decisions that the decision maker for the senior must weigh. The psychiatrist or other practitioner ordering these medications should be asked about alternatives and their risks. Every medication order carries risks and benefits.
Do not be afraid to have the risk-benefit discussion with the treating clinician. It is ok to ask for an opinion from a geriatric psychiatrist, too. The senior with dementia can no longer tell us what is distressing to them. However as a caregiver when verbal and physical behavior impacts on the safety of the senior and their caregiver, it is important to have substantial discussions about these medication alternatives. They are never the first line of treatment, but they should not be overlooked as an important treatment modality for those in need.
Don't be afraid to reach out for help if you need it. Help is always available.