People's PharmacyUse of antipsychotic drugs for the elderly is risky business People's Pharmacy: Use of antipsychotic drugs in nursing homes involves weighing benefits and risks

People's Pharmacy

Weighing benefits against risks is a delicate balancing act. Nowhere is this more apparent than in the prescribing of antipsychotic drugs in nursing homes.

Human Rights Watch recently reported that antipsychotic drugs are administered to more than 179,000 people in nursing facilities every week. These patients have not been diagnosed with schizophrenia or other mental illnesses for which the drugs are approved. Instead, many are suffering from dementia.

The Food and Drug Administration warns, "Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death." The agency notes that antipsychotic drugs are "not approved for the treatment of patients with dementia-related psychosis."

This admonition seems black-and-white. Unfortunately, many people with dementia live in a confusing world with shades of gray when it comes to treatments. We have heard from many readers who are concerned about the new exposé from Human Rights Watch.

One person wrote, "Antipsychotics, if chosen and administered carefully, and if the patient is monitored, can be a real life-saver. My father had multiple strokes that disabled him, and also had dementia and some depression. The medical team at his nursing home collaborated with family to find the right medications to improve his quality of life by easing his extreme agitation.

"Seroquel, at the lowest possible dose, gave him a semblance of normalcy and got him through early evening, which was typically the worst time for him. It's important to find the right medication and to read the literature for side effects. Certain drugs increase the risk of (1) falls and (2) death. Haldol, for instance, is at the top of the list for these risks when used with elderly patients."

Another person had quite a different experience: "My very competent, independent elderly mother had an acute episode of confusion a few years ago. Instead of getting a thorough workup, she got a (ludicrous) diagnosis of Alzheimer's (which they told me must have been in hiding until the previous day).

"When her undiagnosed actual condition continued to get worse, her confusion turned into agitation, so they gave her benzos and ultimately added antipsychotics.

"Two months later, she was a vacant, enfeebled shell of herself and had to be moved to assisted living. I spent two years finding better doctors and working with them to eliminate inappropriate meds, including antipsychotics. Today, she is her old competent, well-balanced, intelligent self - but the inappropriate meds took away her independence and two years of her life."

Still another reader offered a professional's perspective: "I have been on both sides of the issue as well. As a nurse, I see benefits as well as problems with these meds. I am thinking some antianxiety medication is needed at times. It is not a benefit to anyone, including the patients, to have them wandering, crying and agitated all the time. They may attempt to strike the staff.

"I have also seen drooling and patients gorked unresponsive - from too much medication. What quality of life is it to be too agitated and upset? We had to monitor all patients on these meds very closely, and I would rather see them used than having none at all. It is a very tough call."

Walking the tightrope that this nurse describes requires very careful medical oversight. Families need to be involved in decisions regarding antipsychotic medications.

King Features SyndicateQuestions for Joe and Teresa Graedon can be emailed via their website: www.PeoplesPharmacy.com.