Despite a growing body of research that clearly demonstrates that in the vast majority of cases medicating people who live with dementia with antipsychotic drugs does more harm than good, physicians continue to prescribe antipsychotics such as risperidone (Risperdal) and quetiapine (Seroquel) to people who live with dementia, and some family members support these decisions to prescribe.
Why do medical practitioners and family members balk at taking people who live with dementia off these dangerous and largely ineffective drugs? A variety of factors underlie their resistance.
In June 2015, the Canadian Foundation for Healthcare Improvement released the results of a pan-Canadian collaborative project aimed at reducing the use of antipsychotic medication in long-term care facilities for the elderly. The project achieved astonishing results, which I documented here. It showed, for example, that taking people off antipsychotics reduced agitation, reduced falls and reduced resistance to care.
In this clip, Kaye Phillips, Senior Director at the CFHI, and leader of the highly successful project explains two of the reasons families and medical practitioners may want to keep people who live with dementia on antipsychotic medication rather than using non-pharmacological approaches to address expressive behaviour.
More information on antipsychotics.
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My Alzheimer's Story 
Very interesting. My mother has been on a low dose of Risperidone from some years. We have tried to reduce the dosage a couple of times for the reasons made clear here and in other research, but each time it has led to increased anxiety and agitation, so we bumped the dosage back up again later. At the long-term-care home where my mother now lives, I have been told they have successfully reduced the overall amount of anti-psychotic prescriptions in the facility. However, front-line staff on the secure dementia unit tell me that agitation and anxiety levels have increased. This, of course, leads to more noise, more yelling, more screaming etc., which in turn leads to more increased anxiety. A vicious circle. It seems to me that if you are reducing medication (which, again, seems to be a great idea), there will be cases where you need to increase patient/resident support in another area. Not everyone will react positively to a reduction in meds. When I asked the facility what they were adding as supports/treatment to make up for the reduction in meds, they had no answer. The real sticking point, I think, is that the best “treatment” for dementia is human contact, enough staff on hand to hold hands, comfort, listen when the dementia patients are scared. Enough recreation therapy to occupy their minds and calm their fears. However, our medical system doesn’t recognize recreation therapy and companionship from health-care aides as “medically necessary” in the same way that the system recognizes medications, physiotherapy, surgery, radiation, MRIs etc. as medically necessary. They are treated as “nice-to-have” but not essential at the levels required. What we need is to have physicians and the health-care system prescribe companionship and recreation in the same way they prescribe meds and post-op physiotherapy. It might even save money if, as the research shows, it reduces prescription costs, reduces other-side-effects and reduces the risk of falls and injuries.
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“What we need is to have physicians and the health-care system prescribe companionship and recreation in the same way they prescribe meds and post-op physiotherapy.”
Terry, I couldn’t agree with more with everything that you said. I don’t think it works to reduce or remove the medication without at the same time replacing it with something that helps to relieve the cause of the anxiety which may be different for different people and which ranges from environmental factors to boredom and addressing life issues. So it doesn’t surprise me in the least that an attempt to reduce medication in a dementia ward would result in higher levels of anxiety if nothing is done to tackle whatever it is that’s causing the anxiety in the first place.
Coincidentally, I listen to a webinar today in which the presenter suggested that there should be two parallel “prescriptions” to help support people who live with dementia: one “medical,” and one psychosocial/creative which would include things such as art therapy, clowning, yoga, massage, exercise, music, and other strategies. Most important I think is for people to have a sense of purpose and meaning in their lives. I can’t imagine circumstances where this would not involve higher ratios of care staff to residents, and you are right when you say “the best “treatment” for dementia is human contact,” and therein lies the conundrum.
The pan-Canadian project undertaken by the Canadian Foundation for Healthcare Improvement included using a variety of strategies such as those I mentioned in the paragraph above in conjunction with staff training, and a team approach to care plans and implementing the project overall. More in this series to follow. Thanks for your comment.
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As always, Susan, you offer great information. Now, if we can just get the health-care system and the politicians to listen to us, we might just have a chance of doing this right, instead of continuing down a very, very frightening path of over-medicating and locking up, instead of appropriately medicating and holding hands.
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I’m working on it Terry, I’m working on it! Awareness is of course the first step, followed by collaborative advocacy. The more voices speak out, the better the chance of being heard. There are some barriers to this, which will also be the topic of a future post. Part of my individual contribution is to grow the traffic to this blog so that I can reach more people, in addition to developing a network of like-minded souls worldwide. Slowly slowly, one step at a time 🙂
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