Ativan use for Geriatrics

[jamd11]

Hey everyone,

Lately I've been seeing new graduate MDs avoiding ativan.

There was a new MD, freshly graduated, introduced to some patients in the LTC facility, and upon med review weaned them off ativan or took away their prn and replaced with something like quetiapine . The only time I've seen them prescribe ativan was 0.5-1 mg prn (to not exceed a specific dose that I cannot remember) for one month as the new resident had a hx of EtOH and she wanted to cover herself incase the pt went into dts.

Now in chatting with coworkers they said there is research that supports the fact that ativan actually 'worsens' dementia. I have not heard of this nor have I read about it but, was wondering if any of you have see this in practice or heard about the reasoning/research behind it ? I know its a b*tch to wean people off, especially the elders and they can have bad withdrawals, maybe it's to do with this?

Thanks in advance! :)

[chrisrn24]

Typically when we have people with behaviors go to psych units, I see them taken off their narcotics...especially Ativan. something interesting to think about!

[jamd11]

Typically when we have people with behaviors go to psych units, I see them taken off their narcotics...especially Ativan. something interesting to think about!

You know what, back tracking to when I was in a mental health facility (short period), I cant remember giving benzos when I think of it...Mostly IMs of typical and atypicals to control escalating behaviours and moods.... huh interesting. I'm pretty new out of school and I cant remember anything said in regards to psych/dementia patients and ativan in my pharmacology classes.

I think I am going to have to do some sleuthing.

Thanks!

[Micki72]

I worked at a teaching hospital as an LPN on midnights, & dealt primarily with residents. Many of the residents would not order Ativan for geriatric patients stating that it often increases confusion & agitation.

[CapeCodMermaid, RN]

Ativan is a far better choice than Seroquel for agitation than Seroquel or another anti-psychotic. It is sedating but has a short half life and doesn't have as many side effects as the anti-psychotics. I would show those docs the CMS regs on anti-psychotic use in elderly patients with dementia.

Better yet, figure out why the person is agitated and fix that....are they hungry? In pain? Do they need the bathroom?

[txredheadnurse, BSN, RN]

Although the reason is not clinical I do know that many of the Medicare Part D plans now require prior auths for benzos. Maybe the doc doesn't want the hassle of dealing with the prior auth process. In many of the facilities that I serve the medical directors are encouraging the attending physicians to prescribe meds that don't require prior auth since the whole process frequently results in delays in being able to dispense the meds.