Ombudsman's Report for June 2024 - Antipsychotics for Dementia Cause More Harm than Previously Thought
By Kathleen Heren, Rhode Island's Long-Term Care Ombudsman 6.9.24
Many years ago, when I was working as a Long-Term Care Nurse and before the Federal and State laws on not using Antipsychotics as a means of restraint, Thorazine four times a day and at bedtime were routine ways of handling residents with Dementia. The Thorazine could be given orally or by injection. Let's also not forget the residents were also in a Geri chair or tied in a straight back chair with a restraint.
When I think about it now, it makes me physically ill. How could we think inflicting such humiliation on a human being be therapeutic? Antipsychotic medication can still be used but has stricter restraints. The goal for any resident who takes these medications is to reduce the dose gradually.
Antipsychotic use in people with Dementia is associated with an elevated risk of serious outcomes including strokes, blood clots, heart failure, fractures, pneumonia, and kidney disease. The new findings show these drugs cause considerably more damage than previously acknowledged. Despite all the new and safety concerns, the drugs are still being prescribed for behavioral symptoms of Dementia, such as apathy, aggression, anxiety, delirium, and psychosis.
There may be other physical factors that are causing these behaviors. Residents who cannot express pain, such as toothaches, may scream out. The drug may stop the yelling but does nothing for the pain. Another behavior may be depression. The individual may have just lost someone close to them, yet no one calls in a grief counselor. Let us also recognize many falls resulting in a fracture are related to antipsychotics.
What are the answers? Before starting anyone on these powerful drugs, a complete physical with blood work should be completed. A complete neuro-psych evaluation is also a must. Please do not rely on the person's primary care physician.
The person should be evaluated by someone who practices Geriatric Medicine or a Geriatric Psychiatrist. All antipsychotics are not bad if used correctly. Do all the physical and psychological testing before reaching any conclusions on Medications.
Please feel free to contact the ombudsman office if you have any questions at 401-785-3340 or toll-free at 1-888-351-0808.
Kathleen Heren
Rhode Island State Long-Term Care Ombudsman
Office of the RI State Long-Term Care Ombudsman Program
401-785-3340
As the Rhode Island State Long Term Care Ombudsman, Ms. Heren shares her expertise by providing a monthly guest blog to Connelly Law Offices, Ltd in the Ombudsman's Report. In these blogs, she delves into various issues and topics that she encounters in her role. The insights and opinions expressed in these blogs are solely those of the author(s) and do not necessarily represent the views or opinions of Attorney RJ Connelly III or any of the employees at Connelly Law Offices, Ltd. Please feel free to contact our office with any questions.
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