Dementia Meds
There have been reports that some antipsychotic medications used for dementia patients cause a slightly higher increase chance of mortality. Looks like there are going to be some stricter guidelines on using these meds but let’s just hope it doesn’t go overboard. Some demented patients, due to their illness, can be very tough to handle and these drugs may be only ones that work. Obviously, no one needs super high doses to chemically constrain patients. Common sense should rule. What needs to be added to these overreaching recommendations, however, would be “quality of life” because that just may be the most important factor of all.
But if you live in a nursing home you’re not allowed any priority other than length of life. I have put antipsychotics for agitated delerium in my living will. In many circumstances these meds are viewed as “chemical restraints” because when prescribed in large quantities the anticholinergic effect takes hold. Often all you need to do is write for delerium, because then there is clear evidence that they are the best and really only drugs, and the disease is more fatal than the cure. Why we can’t consider some dementias chronic deleriums is beyond me.
The more antipsychotics are studied for agitation in the elderly the more it seems like their benefits are not what we thought and the risks are higher than we realized. Too often these medicines are prescribed in place of the appropriate behavioral and environmental interventions. We often give them not because they’re effective but because there’s nothing else to do. Still, there are many cases where they are useful, though not as many we may think.
I would be interested to know the name of all the meds that shorten the lives of old demented patients. I suspect that list would be quite extensive.