Medicines To Treat Challenging Behaviour
In the later stages of dementia, a significant number of people will develop what’s known as behavioural and psychological symptoms of dementia .
The symptoms of BPSD can include:
- increased agitation
- delusions and hallucinations
These changes in behaviour can be very distressing for both the person with Alzheimer’s disease and their carer.
If coping strategies do not work, a consultant psychiatrist can prescribe risperidone or haloperidol, antipsychotic medicines, for those showing persistent aggression or extreme distress.
These are the only medicines licensed for people with moderate to severe Alzheimer’s disease where there’s a risk of harm to themselves or others.
Risperidone should be used at the lowest dose and for the shortest time possible as it has serious side effects. Haloperidol should only be used if other treatments have not helped.
Antidepressants may sometimes be given if depression is suspected as an underlying cause of anxiety.
Sometimes other medications may be recommended to treat specific symptoms in BPSD, but these will be prescribed “off-label” .
It’s acceptable for a doctor to do this, but they must provide a reason for using these medications in these circumstances.
Get Some Outside Help
A friendly neighbour would be helpful to make sure medication is taken. For example, the friend will help in the event that they are struggling to open pill bottles or blister packs. Again, let the neighbours know about your loved ones condition. The goal, you can give them a call if youre worried. Alternatively, many professional home carers can be put in charge of ensuring that the person with dementia remembers to take their medication.
Flashing LITE-BOX GUIDES Loved Ones to The Right Pills
How To Help Your Alzheimers Patient With Her Medicines
Alzheimers patients often are not able to communicate when something is wrong. They may have a negative reaction to taking their pills for several reasons. For example, she may be having an adverse reaction to a drug and is not able to tell you about it.
One of the more popular Alzheimers disease drugs cholinesterase inhibitors often cause nausea and abdominal pain. Or, your loved one could be having arthritis pain, tooth pain, constipation, a urinary tract infection or dentures that do not fit right. She also could have the flue or a sore throat.
It is even possible that you are trying to give her medicine in a place that is not comfortable for her. If you are giving her pills in the bathroom, she could find the reflections in the mirror upsetting. There also could be a lot of noise from TV or children.
If your loved one is having difficulty taking her medicines, some suggestions from caregivers include:
Give Cues
At first, you may be able to just give the pills to your mother and make sure she takes them. But as the disease gets worse, your loved one may forget what pills are and how to take them.
You can put the pills in your moms hand, and if she does not seem to know what to do with them, try giving her verbal cues. You can tell her that it is time to take her medicine. Then, tell her that this is a pill in her hand, she should put it in her mouth, sip water and swallow it.
Make It A Normal Event
Try to Make It a Game
Other good Alzheimers products include:
Recommended Reading: Can A Teenager Have Alzheimer’s
Finally Make Sure The Medicine Is Truly Needed
There comes a time when dementia is so far advanced that it doesnt always make sense to keep giving some medicines. Pain medicine, nausea medicine, and other medicines needed to keep the person comfortable should be continued. But, there is often no benefit to continuing cholesterol medicine, blood pressure medicine, and others meant to prevent problems in the long term. Talk to the provider about which ones to stop and which one to keep taking. For more information, read the Care Partners information sheet on End-of-Life Care.
Care Partner Information ~ Tips for Providing Older Adult CareEdited by an interprofessional team from the University of Arizona Center on Aging
This project was supported bythe Health Resources and Services Administration of the U.S. Department of Health and Human Services under grant number U1QHP28721, Arizona Geriatrics Workforce Enhancement Program. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
What You Can Do About Medications And Difficult Dementia Behaviors
If your relative with dementia is not yet taking medications for behaviors, consider these tips:
- Start keeping a journal and learn to identify triggers of difficult behaviors. You will need to observe the person carefully. Your journaling will come in handy later if you start medications, as this will help you monitor for benefit and side-effects.
- Learn to redirect and de-escalate difficult dementia behaviors. Contact your local Alzheimers Association chapter or local Area Agency on Aging to find support near you. You can also learn a good approach in this article: 7 Steps to Managing Difficult Dementia Behaviors
- Ask your doctor to help assess for pain and/or constipation. Consider a trial of scheduled acetaminophen, and see if this helps.
- Consider the possibility of depression. Consider a trial of escitalopram or a related antidepressant, but realize any effect will take weeks to appear.
- For all medications for dementia behaviors:
- Monitor carefully for evidence of improvement and for signs of side-effects.
- Doses should be increased a little bit at a time.
- Especially for antipsychotics, the goal is to find the minimum necessary dose to keep behavior manageable.
If your relative with dementia is currently taking medications for behaviors, then you will have to consider at least the following two issues.
The other issue is to make sure you are aware of any risks or side-effects that the current medications may be causing.
You May Like: Do Alzheimer’s Patients Have Hallucinations
Get The Lighting Right
To aid a more restful nights sleep the bedroom should be as comfortable as possible. Using blackout curtains are a good idea during night-time to eliminate outside disturbances. Research suggests that light therapy can reduce restlessness and confusion for people with dementia. Should you wish to consider light therapy, it has been proven that violet coloured light promotes drowsiness and a full-spectrum fluorescent light used for the first two hours of the day can be settling. Light therapy that follows a regular pattern can also help with disturbed body clocks.
Safety – if night wandering is a problem, or frequent visits to the loo, you will need to consider some sort of low light to prevent your parent falling in the dark. You may want to invest in a motion sensor night light. A motion sensor light automatically turns on when motion is detected within three metres. It then turns off after 30 seconds of no activity. This means that people with dementia can use the bathroom in the night or get out of bed with less risk of falling. The light is gentle and warm in order to not interrupt sleep.
- Hard to stay awake during the day and taking frequent naps
- Sundowning, sometimes referred to as late-day confusion.
Sundowning is a dementia-related disorder where a person becomes increasingly anxious and unsettled in the late afternoons and evenings. Sundowning is more often experienced with mid-stage to advanced dementia.
Refusing To Take Medication Refusing To Take Medication
Sometimes, people with dementia refuse to take their prescribed medication. It is important not to assume that the person is just being difficult.
Making decisions and managing difficult situationsMaking decisions and managing difficult situations .
It can be because the medicine is hard to swallow, tastes unpleasant or causes side effects such as nausea.
If this situation arises, you should raise it with the person who prescribed the medication. The prescriber will be able to decide whether or not the person has the capacity to decide for themselves not to take their medication. If the person does not have capacity, then the prescriber will be able to make a decision about what is in their best interests. When making this decision, the prescriber should talk to the persons relatives and carers, and other professionals involved in the persons care. If a health and welfare Lasting power of attorney has been set up, it is up to the attorney to make the decision, with the help of the prescriber.
If it is decided that taking the medication is the best option, then this should be done through the least restrictive means available. In some situations, taking the drug in a different form may be easier than swallowing a pill. For example, some dementia and painkiller drugs are available as a patch or an oral solution.
Read Also: How To Help A Loved One With Dementia
Sleep Aids For Dementia Patients
Sleep inducing medications can cause negative side effects in dementia patients. These include worsened cognition and an increased risk of falling. Therefore, recommended sleep aids for people living with dementia are non-drug based and aim to improve sleep routine and the sleeping environment. You can find a full list of dementia products on our dementia products page.
Things For Carers To Think About Around Medication:
- Are there some situations where the person is more comfortable taking the medication, and others less so eg, in a particular setting or with the help of a particular person?
- Can you tell from the persons reaction that they dislike the taste, or that the drugs cause unpleasant side effects?
- Does the person have capacity to refuse to take their medication?
- Have you asked the GP about alternative forms of the medication?
- If you are tempted to try hiding medication in food, have you had this approved by a qualified medical professional first?
Read Also: Medicine For Dementia And Alzheimer’s
No Easy Solutions But Improvement Is Usually Possible
As many of you know, behavior problems are difficult in dementia in large part because there is usually no easy way to fix them.
Many probably too many older adults with Alzheimers and other dementias are being medicated for their behavior problems.
If your family is struggling with behavior problems, I know that reading this article will not quickly solve them.
But I hope this information will enable you to make more informed decisions. This way youll help ensure that any medications are used thoughtfully, in the lowest doses necessary, and in combination with non-drug dementia behavior management approaches.
To learn about non-drug management approaches, I recommend this article: 7 Steps to Managing Difficult Dementia Behaviors
And if you are looking for a memory care facility, try to find out how many of their residents are being medicated for behavior. For people with Alzheimers and other dementias, its best to be cared for by people who dont turn first to chemical restraints such as antipsychotics and benzodiazepines.
This article was first published in 2016, and was last updated by Dr. K in May 2022.
Taking Medicines Safely As You Age
On this page:
Medicines are intended to help us live longer and healthier, but taking medicines the wrong way or mixing certain drugs and supplements can be dangerous. Older adults often have multiple medical conditions and may take many medicines, which puts them at additional risk for negative side effects. Read on to learn how to safely take and keep track of all your medicines.
Don’t Miss: Is Hearing Loss Associated With Dementia
How To Get Dementia Patient To Take Their Medications
by hcstraightup | Oct 23, 2019 | Caregiver, Dementia
At your wits end trying to convince your dementia loved one to take their medications? You are not alone! This is a problem experienced by caregivers everywhere, not just home caregivers, but also by nurses and employees who work in memory care units. Although our initial instinct is to assume that your loved one is being difficult, it is important to explore the possibility that they may have a specific reason they are avoiding their medications.
In any case, finding ways to get your dementia loved one to take their medications isnt always and easy feat, but persistence, trial and error and a bit of love and luck is probably the best place to start. Good luck and down the hatch!
The information you need . . . straight up!
What To Do If Swallowing Pills Is A Problem
Many people with dementia have trouble swallowing. If you are running into this problem it may be easier to swallow pills if their head is tilted forward . You can also ask your pharmacist if the medicine comes in liquid form. If it does, you can give the medicine with a spoon or a cup, or mix it with food.
If it doesnt come in liquid form, you may be able to crush pills or open capsules and mix the medicine in a spoon with applesauce, pudding, yogurt, or other soft food. But, it is important to know that some pills or capsules must never be crushed or opened. It can be dangerous to do so. Be sure to check with your pharmacist. The table below lists words in a medicines name that tell you it should not be crushed or opened. Here is a detailed list of medicines that should not be opened or crushed.
|
Do Not Crush Pills or Open Capsules If
|
Read Also: How Often Does Alzheimer’s Occur In The Population
Practical Tips On Medications To Manage Difficult Behaviors In Dementia
You may be now wondering just how doctors are supposed to manage medications for difficult dementia behaviors.
Here are the key points that I usually share with families:
- Before resorting to medication: its essential to try to identify what is triggering/worsening the behavior, and its important to try non-drug approaches, including exercise.
- Be sure to consider treating possible pain or constipation, as these are easily overlooked in people with dementia. Geriatricians often try scheduling acetaminophen 2-3 times daily, since people with dementia may not be able to articulate their pain. We also titrate laxatives to aim for a soft bowel movement every 1-2 days.
- No type of medication has been clinically shown to improve behavior for most people with dementia. If you try medication for this purpose, you should be prepared to do some trial-and-error, and its essential to carefully monitor how well the medication is working and what side-effects may be happening.
- Antipsychotics and benzodiazepines work fairly quickly, but most of the time they are working through sedation and chemical restraint. They tend to cloud thinking further. It is important to use the lowest possible dose of these medications.
- Antidepressants take a while to work, but are generally well-tolerated. Geriatricians often try escitalopram or citalopram in people with dementia.
Make Sure You Know When To Give The Medicine
Some medicines should be given with meals, while others should be given on an empty stomach. Some should be given in the morning, while others should given before bed. Some are taken once daily and some are taken several times each day. Be sure you know when each medicine should be given, and what it is used for.
Don’t Miss: Is Lewy Body Dementia Contagious
Pill Box Medication Reminder With Alarms
There are many medication reminders with alarms available. For example, the Med-Q Medication reminder for dementia suffer. A smart reminder will guide the user to the correct doses. If the person you care for forgets to take their pills, a smart reminder will repeat its alarms and reminders. They twill have an alarm to alert the person that its time to take the pills.
Medicines To Treat Alzheimer’s Disease
Several prescription drugs are approved by the U.S. Food and Drug Administration to help manage symptoms in people with Alzheimers disease. For some people, these medications may help slow down certain problems, such as memory loss. Slowing down memory loss can allow many people with Alzheimer’s disease to be more comfortable and independent for a longer time.
In 2021, the FDA approved a new medication, aducanumab, through the accelerated approval pathway. The medication helps to reduce amyloid deposits in the brains of people with Alzheimers but has not yet been shown to affect clinical symptoms or outcomes, such as progression of cognitive decline or dementia.
Most medicines work best for people in the early or middle stages of Alzheimers. However, it is important to understand that none of these medicines can cure or stop Alzheimers. Visit How Is Alzheimer’s Disease Treated? for more information on medicines to treat Alzheimer’s and behavior symptoms.
Also Check: Are Alzheimer And Dementia Hereditary
They Wake Up A Lot During The Night To Use The Loo And I’m Worried They May Get Lost Or Confused Should I Wake Up Too To Help Them
It is normal that older people will need to use the loo more often during the night. This can be difficult if a person also has dementia as they might forget why they’re up, where the toilet is or that they should go back to bed. Start by looking at your parents drinking and eating habits. If they are eating and drinking large amounts in the evening this will increase the need for them to visit the toilet. Limit their intake from late afternoon and enjoy a main meal at lunch. Next make the route to and from the toilet as clear as possible by using signs and plug-in nightlights. Try using pictures if it helps. It might also help to make the lights in the bathroom motion activated for when they get there. If you are still worried or you find they still get lost, it may be that you will have to help them. A monitor or bed-exit sensor will help you to wake up when you need to.