Namenda/Aricept/Excelon...is it worth it?

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    i am just curious to all the nurses out there...and those that work in ltc are probably more familiar with this than some others....have you ever seen, and i mean visibly,physically, mentally seen any resident improve after starting namenda, aricept or exelon? i work at 3 different ltc facilities and my ft place is slam full of these meds....on people that are so far demented they almost are just....vegetative. ive seen our lovely wonderful (sarcasm there) psych person put 98 yr old demented residents who are total care on namenda taper packs and aricepts along with that stinkin excelon patch....and ive yet to see it work once on anybody. even the ones who have had mild dementia that were put on it....they seem worse to me.....staying up all night, more confusion, hallucinations/delusions.....plus...these meds are expensive. the other 2 facilities i work at...has just a few residents on these meds who look and act better than most at my ft job. ... my thought is this.....why would anybody with the authority to rx meds put someone so far gone on it? i also just read that these meds have no proof that they truly slow down alzheimer type demetia. so much conflicting info...but just from my own experience watching this med...i think it uselss and a waste. i think it might work on someone if you started taking it in your 30s/ 40's ....but you would basically have to be sure you were going to get some type of dementia...and who can say for sure that any one of us will? what got me started on this research was when i had a resident who had broke her shoulder and leg...60 yrs old..yes...just 60....young beautiful lady....with full blown alz. type dementia....she could not speak..only could make weird sounds that were repetitive...she was ambulatory..but couldnt understand or follow directions. she according to her hubby had been dx with alz type dementa about 10 years ago...which would be..in her 50s. how did that happen to this woman???? every time i would look at her and talk to her....she just looked right thru me like absolutely nobody was home..no lights on ...nothing. it just broke my heart to see someone this young like this. she wasnt on any type of dementia meds...nor has she ever been according to the hubby. ugh.....its so sad. and no family hx according to the hubby...absolutely heart breaking. i cant even really describe it....the first time i met her and her hubby....my chest physically ached for these people. what is your take on these type of meds? just in general?
    Last edit by sasha2lady on Apr 28, '10 : Reason: mis spelled words
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    I think that often, doctors are just covering their butts by describing any meds that "might" help. I have been working in long term care for over two years and the majority of the patients have dementia of some form. And no, I have never seen any of these meds help.

    Although it would be hard to know for sure. When someone has advanced dementia, the only time I have seen meds help them was in the case of agitated, upset patients. Prescribing seroquel and sometimes ativan will help to calm them down considerably and when taken routinely, makes them easier patients to care for in general.

    But as far as improving their cognition? No real evidence of that once they are in our facility.
    SuesquatchRN and Fiona59 like this.
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    Exactly. We use Ativan Xanax etc meds for behaviors and anxiety that work more often than not. I asked our pharmacist what price range aricept namenda runs it's roughly 200 a month for each. Ridiculous.
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    I've done LTC most of my career. In my opinion, MOST of the meds that these people are taking are not necessary, and have such horrible side effects, they would be better off NOt taking them. Statins, as well as the "alzheimer's meds" have had no effect on anyone I have seen taking it over the years. I believe it also has to do with the drug companies and their bottom line-the almighty dollar! And people wonder why health care costs so much. Just my , but it really burns my butt!!!

    Barb
    itsmejuli, eldragon, and Fiona59 like this.
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    Aricept is a drug families clutch at because of the hope of delaying the effects of the disease.

    My friend's Dad was on it for two years. His family doctor stopped it because the disease was progressing. I guess we do things differently up here in Canada. It's an expensive drug and yes it is prescribed (and usually paid for by the government) but it seems as if the GP evaluates the use carefully and will stop it. How often are your residents/patients evaluated.

    Here's one to consider. There is a canine version of Aricept used to treat Canine Cognitive Disorder (aka Doggy Alzheimers) The symptoms are similar to the human disease.

    http://dogs.about.com/cs/disableddog...disease102.htm

    There is even a mini mental for dogs scored out of nine. Vets rarely prescribe the drug because it's expensive and only helps for about 6 months. I knew a dog who used it. It helped for a short while. Other dogs were turned down for it because their disease was too advanced (mini mentals 1/9, 0/9).

    Sometimes I think we treat our companion animals better than our parents.


    Oh, and while we're on the subject of useless LTC drugs. Premarin for a 96yo, demented, incontinent, bed bound patient?? Why?
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    Quote from Fiona59
    Oh, and while we're on the subject of useless LTC drugs. Premarin for a 96yo, demented, incontinent, bed bound patient?? Why?
    It can help with chronic UTIs.

    Yhe benefits of these drugs have been proven, but they have also been shown to be useful for only a short period of time. I think docs here don't d/c them because we are so tightly controlled be regulations. Namenda, yes. Seroquel, justify.
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    She had no history of UTI's just scratching and biting staff. She'd been there 15 years and some of the long time staff knew her from day one.

    anyhoo, sometimes I think it's just easier for the Drs to write a generic repeat order for their patients rather than figure it out.
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    Quote from Fiona59
    She had no history of UTI's just scratching and biting staff. She'd been there 15 years and some of the long time staff knew her from day one.

    Then I got nuthin'.

    I got attackers. Gah.
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    Quote from Fiona59
    Oh, and while we're on the subject of useless LTC drugs. Premarin for a 96yo, demented, incontinent, bed bound patient?? Why?
    To increase her risk for DVT so you can send her to the hospital? I dunno.
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    I think that drugs like Namenda,Aricept and Excelon are pretty much a joke in the long term. They may work for a short period of time, but personally I see no long term improvement. I've worked long term care for going on 2 years and many of residents are prescribed these meds. People who are so far demented that they no longer walk, talk or reconize family members. I n my facility meds such as Xanax,Ativan and Risperdal occas Seroquel are used to control behaviors. I've seen our house MD order a Namenda taper for a 96 year old woman whose dementia was so progressive that it in my opnion was completly usless. Only when he ordered 12.5 of Risperdal IM q 2weeks and 1.5 of po risperdal daily did her behaviors even change in the slightest. The po form was recently DCD and she's back to throwing things at staff and trying to escape the building.
    Fiona59 likes this.


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