Anti-psychotics and geriatrics

SuesquatchRN, BSN, RN · Feb 19, 2009

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.

Whispera, MSN, RN · Feb 19, 2009

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...

Katnip, RN · Feb 19, 2009

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.

systoly · Feb 19, 2009

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.

CapeCodMermaid, RN · Feb 20, 2009

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.

SuesquatchRN, BSN, RN · Feb 20, 2009

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.

ktwlpn, LPN · Feb 20, 2009

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...

systoly · Feb 20, 2009

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.

michael79 · Feb 21, 2009

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.

systoly · Feb 21, 2009

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.

Isn't it cool? As soon as you're done validating the client's individuality, make sure they fit the statistics.

freddiebear · Feb 28, 2009

Its classified as a chemical restraint. We need to be sure that we dont use them for staff convienance. They can have toxic effects on some people and cause a decline in function. If someone is nonambulatory I dont think they can cause much damage to themselves or others even though it can present a problem when trying to provide direct care. Res. that are combative and resisitive to care are a challenge.