Long acting antipsychotic

[riverkinz]

I am a psychiatric nurse that works in a dementia care unit. We have one resident that has alot of behaviour issues. Keep in mind I am working with the elderly. She gets physically abusive with care and she will not take any medications. We end up putting her medication in her food but she often skips meals. There is also a language barrier here. We have tried everything when it comes to approach, interpreters etc.....she also has hallucinations, talking to herself or to someone who is not there. She also had a visual hallucination that she mentioned to another care staff who speaks her language. I am going to pass this by the doctor but was wondering about long acting antipsychotic intramuscular injection. Since she is not consistent with her medications then I am thinking this would be a good route. Just wondering if anyone has experienced this medication use with the elderly and how it has worked. thanks

[Whispera, MSN, RN]

The injectables work well in controlling symptoms, and are also side-effect causers, and with elders one always must be very careful. Check into antipsychotics that melt in the mouth (you put one in the mouth and it just poofs) , or liquids that can be put in small amounts of juice.

I don't like to give injections to elders, because they HURT and their skin can be so thin and easily injured.

[RNKel, ASN, RN]

Is it OK to put it in their food? Does she know it's there?

[Elektra6, ASN, BSN, RN]

Our psych dr prescribed these for several non-compliant geriatric residents in our LTC. They were great because you only need to administer them monthly if I remember correctly. They worked as well as daily meds IMHO. Worth a mention to the doc.

[lpnflorida, LPN]

I had seen haldol deconoate used in specific patients, it is not a panacea though. I am not sure I would recommend one the long acting psychotropics for the elderly.

[Whispera, MSN, RN]

Haldol and Prolixin are the usual decanoates. Both are prone to high incidence of extra pyramidal symptoms and tardive dyskinesia. Recommending them for long term use isn't something I'd do, especially for an elder.

[ghillbert, MSN, NP]

Risperidone (Consta) long acting depot formulation IM? Dosed every 2 weeks. Some evidence in elderly. Can trial PO before going IM, little to no extrapyramidal effects.

There is an FDA warning regardly eldely dementia patients, risperidone and stroke/stroke-like symptoms.

http://www.medscape.com/viewarticle/423206

[Whispera, MSN, RN]

I agree with ghillbert. However, Consta is very expensive so that needs to be considered too.

[riverkinz]

thanks I'll mention it and see how it turns out. This resident has dementia. She is not aware of medication in her food. She is not mentally capable of making that decison which is indicated and signed for in her chart by both family member responsible and doctor. thanks for your input.

[TheCommuter, BSN, RN]

IM injections of Geodon seem to work extremely well in the elderly, demented residents with behavioral issues at my workplace.

[Whispera, MSN, RN]

Geodon isn't long acting like the decanoates though, and also costs a bundle.

[Mr Ian]

Since no one talks her language - it's no wonder she talks to herself Who else has she got?

Can the nurse who she can communicate with be utilised better? In elderly care half the battle is sheer confusion and misunderstanding.

Risperidone is now indicated for behavioural disturbances in dementia.

That's mostly because they want to sell more of it.

It does have some benefits but I would be cautious. Older typical antipsychotics are not advisable due to the known s/e's and you're only going to make her more grumpy or increased falls risk.

Since she's 'non-concordant' with taking oral medication and does not have understanding/capacity to realise what is going on around her - what's it going to be like to hold her down and inject her?

For me her behaviour would have to be fairly distressed/distressing to go the pathway of depot/long acting and I';d want to exhaust all alternatives first - it is a last resort.

Then I would support a trial of one or two perhaps but - subject to the clinical response and the distress 'cost' of enforcing this sort of medication - I could be easily swayed against it.