Kapok Aging and Caregiver Resources: The Silent Crisis of Benzodiazepines, Antipsychotics and Dementia Care
Narration provided by Wondervox.
Reprinted with permission from Kapok Aging and Caregiver Resources
By
Even with my decades of experience in elder care and gerontology, navigating dementia care for my father was nothing short of overwhelming for my family. Nevertheless, despite all the challenges, my dad spent all but one month of his 18 years with Alzheimer’s, cared for by my mother at home.
Sadly, his last month was spent in a memory care facility (and on hospice care) until he died in the hospital after a bad fall and severe head injury in the facility. He was on lorazepam (Ativan®), in the category of benzodiazepines, despite his risk of falling and a body of scientific evidence describing this medication to be contraindicated for individuals with dementia.
Like many of you caring for someone with Alzheimer’s or dementia, we second-guessed our every move and trusted others.
Since his passing, our family has grappled with a lot of ‘should’ve,’ ‘would’ve’ moments and regrets as we look back and think about what we could’ve done to better advocate for his wellbeing.
While we can’t publicly comment on the details of our active investigation into his death in May 2023, I wish only to empower our readers with information so they avoid the same fate.
In this series of articles, we will take a close look at the use of benzodiazepines, antipsychotics, and related medications and their relevance for dementia. As you’ll see, the combination of medications like antipsychotics and dementia care is often ill-advised, ineffective, and sometimes outright dangerous.
We’ll also explore state medication policies on the prescription of benzodiazepines and antipsychotics, along with the rights patients and families have regarding medication decisions.
It’s crucial for family members to understand these very real risks of antipsychotics in dementia care, especially as healthcare staff may not provide a complete picture. Never make any assumptions. Instead, do your due diligence so that you have a clear picture of the risks and potential benefits of each decision.
How Some Medications Are Misused in Dementia Care
Medication is certainly important in dementia care, especially for treating co-occurring conditions or other health problems, such as antibiotics for an infection.
However, there are also many cases where medications are used inappropriately.
Benzodiazepines, antipsychotics, and other medications that affect the brain are especially relevant here. These are sometimes used as a way to decrease aggression in people with dementia. Sometimes, they’re even used to punish patients who are not behaving in the way the nursing home wants.
The practice is sometimes called a chemical restraint, as the medication actually limits the patient’s ability to engage with the world. Family members speak of previously engaged and dynamic people barely moving or talking once on the medication.
Such issues are especially common in nursing homes with a higher proportion of low income residents and those where skilled nursing hours are low.
It’s a concerning pattern, given the medications used aren’t approved for helping with dementia or dementia-related behaviors.
Yet, the appeal is easy to see. The medications potentially make dementia patients more complacent and easier to deal with, especially on high doses. That’s helpful for short-staffed organizations and those with a strong focus on efficiency.
The Dangers of Benzodiazepines, Antipsychotics and Dementia Care
Benzodiazepines and antipsychotic medications can pose significant risks to patients with dementia, making it essential for healthcare providers and caregivers to exercise caution when considering their use.
The American Geriatric Society (AGS) BEERS criteria, a well-respected authority in geriatric medicine, provides guidelines and recommendations for medications that should be avoided or used with caution in older adults, including those with dementia.
About Angelica Herrera Venson, DrPH, MPH
Founder of Kapok Aging and Caregiver Resouces
Angelica Herrera Venson, DrPH, MPH is a gerontologist born in San Diego and raised on both sides of the U.S-Mexico border. She’s a public health advocate who has spent two decades in community health work and research investigating how immigrant and racial /ethnic minority family caregivers and seniors navigate old age and seek out health and elder care. Today, Angelica supports some of Arizona’s community health centers, which serve primarily Medicaid and underserved communities, in their transition to value-based care.
About Multicultural Guide to Caregiving
Author and gerontologist, Angelica P. Herrera Venson, DrPH, opens up and shares her family’s personal stories and lessons from her field work and research on aging and caregiving with communities of color and first generation Americans.
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