Keyword: “antipsychotic prescriptions elderly”
By Amanda Reseburg
When a loved one is experiencing dementia-related restlessness or other signs of restless behavior that can come with age and diminishing mental capacity due to senility, it can be easy to agree to the prescribing of antipsychotic medications for their condition. While these popular prescriptions can seem to help dull the desire to wander or have “sundowning” behavior in the elderly, they can also come with a host of safety risks that many family members and caregivers are in the dark about.
The overprescription of antipsychotic medications among the elderly has quietly become a healthcare crisis, especially in long-term care and nursing facilities. In older adults who may have dementia or other conditions that limit mental capacity, the safety risks of these medications can far outweigh the little benefit they may offer.
Ellen Lubensky can relate to the concern many have over the prescription of antipsychotics. After being misdiagnosed and given a prescription for benzodiazepines for years, she has become an advocate for those who have never been given the full breadth of information about what potential harm these medications carry and what alternatives are available.
“These drugs are often used far beyond the narrow situations where they may be of some good,” explains Lubensky. Now, she is on a mission to educate and help others find a better path to healing.
Elder Care and Antipsychotic Prescribing
While typically used for conditions like schizophrenia, antipsychotics are often prescribed to older patients to manage behavioral symptoms such as agitation, hallucinations, or dementia-related distress and restlessness. Recently, the Department of Health and Human Services issued a concerning report about antipsychotic drug use among nursing home residents, especially for patients with dementia. The report called for steps to be taken to reduce the inappropriate use of antipsychotics, though whether it will make a dent in the long-term reliance on the practice remains to be seen.
For Lubensky, the fact that many elderly patients are on multiple medications that can heighten the adverse effects of antipsychotics is one of the most worrying aspects of the issue. “These medications may be used as a quick fix rather than a last resort option,” she explains.
Informed Consent and Higher Risks in Geriatric Patients
Lubensky’s advocacy centers on informed consent, which can become muddled when working with elderly patients who may not be able to make their own healthcare choices or understand the educational resources provided to them. “Informed consent means that decisions for older adults concerning medication should be made with more thought and caution,” she says.
Today, few treatment plans for older adults, especially those with dementia, focus on the issue of informed consent. Safety, individualized care, and dignity can also be set aside, especially if the patient’s restlessness or behavior is the primary concern. “Antipsychotics have their place in mental health care, but can be prescribed too casually to those with dementia,” explains Lubensky.
Antipsychotics are not approved by the FDA to treat dementia, but have been employed to manage the various symptoms of dementia patients. However, the sedative effect of many of these medications can pose major risks for elderly patients who are prone to dangerous falls, eloping, and breathing concerns, leaving the use of these medications to carry a very real risk of death.
“Sedation is not treatment,” says Lubensky. “It simply masks behavior.”
In fact, the FDA issued a black box warning for antipsychotics used for elderly patients back in 2008. However, this did not slow the incidents of caregivers using the medications to manage symptoms of dementia and other conditions, often without proper informed consent.
The Consequences of the Overprescription of Antipsychotic Drugs
Lubensky has lived with the consequences of the overprescription of antipsychotic medication. Over the course of 28 years, she took benzodiazepines for a condition she was told she had. Due to the use of the medication, she developed tardive dyskinesia, a debilitating movement disorder caused by long-term use of certain psychiatric medications, and is now several years into her mission to completely taper off the medication
It was this experience that moved Lubensky to be an advocate for others. “We are in a system that rewards convenience, and this is especially true in elder care,” she says.
Indeed, staff in nursing homes and long-term care facilities can face staffing shortages, time constraints, and a lack of training. Each of these factors can make the sedating effect of antipsychotic medications appealing, even when pain support, behavioral health support, or environmental changes could be more appropriate.
Responsible Care for Elderly Patients
Families and caregivers may wonder what they can do to better advocate for their loved ones who may not be able to give informed consent to antipsychotic medications. “I suggest asking a series of questions,” says Lubensky.
According to Lubensky, these questions include inquiries into why their loved one’s healthcare provider believes the medication is necessary and whether the core issue behind their behaviors or restlessness has been explored. For example, UTIs in older adults can often cause hallucinations and agitation; however, if that possibility is never considered, the patient’s worsening condition can cause worsening behaviors.
The rise in antipsychotic medication in older adults is a concern, highlighting a larger failure in treating elderly patients with caution and nuance. A safer path to medicating means looking beyond behavior control and considering a care path that keeps dignity and long-term well-being as the primary focus.
Disclaimer: The information provided in this article is intended for general informational purposes only and should not be construed as medical advice. It is important to consult with a healthcare provider before making any decisions regarding the treatment or care of elderly individuals.
