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Anti-psychotics and geriatrics



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Feb 19, 2009 06:00 AM

Anti-psychotics and geriatrics


Our geriatric pharmacist is urging us to contact our docs and ask them to d/c any orders for anti-psychotics such as Seroquel or Risperdal. They say that both are unsafe and ineffective in use with seniors with dementia and can actually increase mortality. My questions are: Are you seeing this push to take them off anyti-psychotics and what do you replace it with if they have behavioral issues?

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25 Comments
No. 1
from SuesquatchRN
Old Feb 19, 2009, 06:15 AM

Default Re: Anti-psychotics and geriatrics
Well, unsafe and ineffective are relative. I have seen them work for some of the psychoses.

The pharmacist is protecting himself because the FDA has required that a "black box" warning be added to these meds for use in the elderly.

There are no alternatives.
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No. 2
from Whispera
Old Feb 19, 2009, 08:54 AM

Default Re: Anti-psychotics and geriatrics
agreed..safe and effective are relative...

Sadly, elders don't metabolize or excrete like youngers. Extreme care must be used with antipsychotic medications. Tiny doses may be effective though. It's difficult to figure out sometimes.

As far as dangerous goes, yes, these drugs are dangerous to elders, but hallucinations, delusions, paranoia, and outbursts of emotion are surely not comfy nor conducive to quality of life. Benefits vs. barriers...
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No. 3
from Katnip
Old Feb 19, 2009, 11:25 AM

Default Re: Anti-psychotics and geriatrics
Originally Posted by Whispera View Post
As far as dangerous goes, yes, these drugs are dangerous to elders, but hallucinations, delusions, paranoia, and outbursts of emotion are surely not comfy nor conducive to quality of life. Benefits vs. barriers...
My thoughts exactly. Just because they get old, their mental illness does not go away. Unfortunately there are no viable alternatives at this time for them.
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No. 4
from systoly
Old Feb 19, 2009, 01:59 PM

Default Re: Anti-psychotics and geriatrics
I've seen the meds in question replaced with hormones (in male pts.) and anticonvulsives. The problem with the later is that when labs come back at a subtherapeutic level, someone will call the Doc on call and get the dose increased, not realizing that we're not using it to control seizures.
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No. 5
from CapeCodMermaid
Old Feb 19, 2009, 07:08 PM

Default Re: Anti-psychotics and geriatrics
I just read an article which said that Aricept and Reminyl are helpful for psychotic behaviors in the elderly. I'm thinking the company that makes those meds sponsored the article. I've never seen either one of them help. The sad truth is most of our facilities don't have the staff it would take to deal with psychotic seniors so we medicate them.
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No. 6
from SuesquatchRN
Old Feb 19, 2009, 07:35 PM

Default Re: Anti-psychotics and geriatrics
Originally Posted by CapeCodMermaid View Post
The sad truth is most of our facilities don't have the staff it would take to deal with psychotic seniors so we medicate them.
The world doesn't have the resources to deal with psychotic people, period. They can be dangerous to themselves and others.
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No. 7
from ktwlpn
Old Feb 20, 2009, 04:14 PM

Default Re: Anti-psychotics and geriatrics
Originally Posted by michael79 View Post
Our geriatric pharmacist is urging us to contact our docs and ask them to d/c any orders for anti-psychotics such as Seroquel or Risperdal. They say that both are unsafe and ineffective in use with seniors with dementia and can actually increase mortality. My questions are: Are you seeing this push to take them off anyti-psychotics and what do you replace it with if they have behavioral issues?
We make the doc,the psychiatrist and the family all aware of the pharmacy's recommendation.Many of the s/o's understand that dementia treatment is about comfort in the moment and are very adamant about keeping their loved ones as comfortable as possible and will advocate for their family members when it comes to suggested med changes.We continue to use the meds that have proven effective if that is what the family wishes...
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No. 8
from systoly
Old Feb 20, 2009, 04:41 PM

Default Re: Anti-psychotics and geriatrics
From what I understand, it involves a lot of statistics. A unit manager may be urged to reduce the number of psychotropics on their unit, because the unit is above national average, however, no differentiation is made between a dementia/memory loss unit versus a health care center.
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No. 9
from michael79
Old Feb 21, 2009, 08:35 AM

Default Re: Anti-psychotics and geriatrics
Originally Posted by systoly View Post
From what I understand, it involves a lot of statistics. A unit manager may be urged to reduce the number of psychotropics on their unit, because the unit is above national average, however, no differentiation is made between a dementia/memory loss unit versus a health care center.
This is exactly what is happening on my unit. I feel intense pressure from corporate to reduce the number of psychotropics as well as our DUR to below the national average. These are also non medical people urging us to do these things.
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