When are mood altering drugs or drugs used for altering behavior a good thing? If a Nursing Home is drugging your aging parents to keep them manageable and placid is that a good thing? Is it an appropriate form of help? Should it be temporary or is long-term justified?
Many boomers, in their youth were hippies and part of a youth culture that experimented with recreational street drugs. Now at a different life stage some of them find themselves questioning the drug use of their parents, or even their own use of drugs. These are loaded questions. Questions we may prefer we didn’t even have to wrestle with answering.
However, the reality is at some point we or friends of ours will be faced with these concerns. The first step is to arm yourself with information. What are the drugs intended to control and why? What are the side effects? What are the risks of both the drugs and refusing the drugs?
Behaviors such as agitation, anger, wandering, aggression, intrusiveness, and other anti-social behaviors are of concern particularly in group living situations where the behavior of one person can impact others. Some medications prescribed for other medical problems, such as thyroid problems, may result in behavioral changes. Emotional responses such as fear, anxiety, and disorientation following a move or early stages of dementia resulting in restlessness or wandering are often met with drug intervention.
Drugs for Grandma Behavior Modification in Care
Perhaps, short-term prescriptions may ease a transition. However, the question still remains “What are the pros and cons of accepting or rejecting such interventions.” When are the rights of the individual sacrificed for the convenience of others? Of course, there are no consistent answers. Assessing the probability of self-harm or harm to others and an investigation of the potential side-effects should be undertaken before unquestioningly filling a prescription. Consideration of the individual, the environment, and others involved should be weighed into the decision.
None of us would want caregivers whether they are family members or employees in a Nursing Home to put them in harms way by caring for someone who is exhibiting aggressive outbursts of anger. However, clear communication with the patient or modifying the environment to ease a transition may be all that is necessary. The onlooker may consider the elder recently moved to a Nursing Home as unruly. While the elder may be reacting to feeling their personal power being ripped away from them. None of us at any age adapt quietly and peacefully to involuntary change.
The more powerless the person feels the more the natural fight or flight response will be. Even as parents age, their rights to an opinion about their living arrangement needs to be met with understanding. That is not to say they can live independently if they can’t do so without being in danger of harming themselves. Nevertheless, engaging the elder in the decision making process and allowing them to play an active role in decisions can make it an easier transition for all concerned.
Am I dreaming, you ask. Some seniors fight the move to Nursing Homes with every ounce of their being. Yes, that is true. But, understand this. If their perception of the move is that it is one leg in a coffin – of course it will be met with resistance. In a time of crisis is the hardest time of all to develop communication skills. It is so easy to see our side of any argument at any age.
While dementia may result in making communication next to impossible, or impossible, there comes a time when choices have to be made by those who are closest…no matter how difficult those choices are. Those choices also include decisions about drugs to intervene in modifying behaviors. Unbridled use of drugs for behavioral control of others in our lives, whether they are seniors or not, is only different to physical restraint in that it is not a visible method of restraining the individual subjected to the drugs.
Perhaps, nonetheless, medication is the most appropriate and effective method of providing the individual with peace of mind and freedom from additional physical and psychological traumas. When one is very anxious it can result in other physical challenges – altered eating behaviors, inability to sleep, aggression toward others or self-harm.
However, in almost all cases the patient should be given the right to accept or reject mood or behavior altering drugs. If it drugs are routinely administered by a Nursing Home to all newcomers, perhaps you should be looking for a different facility. Convenience is not a symptom of paxil or seroquel deprivation. If medications are prescribed, monitoring and reviewing dosage and need is mandatory. All too often, once an individual is put on a behavior modifying drug, they are not taken off it.
Responsibility for monitoring, tapering off or stopping medication falls back to family members. Minimum possible dosages, and shortest durations are the best alternative. It is a known fact that aging people do not metabolize drugs as easily and many antidepressants and other mood altering medications can lead to physical and psychological dependency. Many caregivers fail to communicate with the Nursing Home that they wish to be informed of changes to medications and consulted prior to adding or increasing dosages, except in the case of medications administered in emergency situations for physical health related issues. Even then communication is key.
It has been said that a person who has six personal friends will never need counseling by a counselor of psychologist. It proves true, the more we are able to discuss and share life’s ups and downs before the situations become a problem, the less likely it is to escalate. Perhaps the biggest reason so many residents in care homes end up on anti-psychotic drugs, anti-depressants or similar drugs is not so much because these problems become more prevalent with age but that often as people age their personal friends pass on and younger family members become so engaged and preoccupied with their own lives that the elders are left alone and become lonely at a time in life when they most need to be recognized for the rich life they have lived.
The most important aspect of the care giving role when caring for aging family members is ‘care’. When decisions are made because you truly with love ‘care’ the decisions will be in the best interest of the elder. All medications have side effects and risks in addition to benefits.
Disclaimer: This article is not written with any intent of interfering with medical advice, rather it is written to explore options and to encourage all consumers to recognize that drug companies are businesses and as consumers we should ask questions and be knowledgeable.
Here is a list of commonly used drugs used with aging populations:
(Listed with brand name first and generic name second.)
Ativan (Lorazepam): Anti- anxiety. Generally not recommended for the elderly. Part of benzodiazepine family and can be addictive.
Celexa (Citalopram). An antidepressant. Depakene (Valproic Acid): Originally used to treat seizures or bipolar disorder. Used with the elderly as mood stabilizer.
Desyrel (Trazodone): Original purpose as anti depressant. Now used as sleeping aid. Sometimes used in small doses to control daytime symptoms of anxiety or restlessness.
Neurontin (Gabapentin): Original use as anti-seizure, also used for control. of pain related to nerve damage. May also be used with the elderly as mood stabilizer.
Paxil(Paroxetine) An antidepressant.
Prozac(Fluoxetine): An antidepressant. Not generally recommended as a first choice for the elderly.
Risperdal (Risperidone): Original purpose antipsychotic. Used in elderly for anxiety, paranoia, agitation, aggressive behaviour or mood stabilization
Seroquel (Quetiapine) Original purpose antipsychotic. Used in elderly for anxiety, paranoia, agitation, aggressive behaviour or mood stabilization
Zopliclone (Imovane): Used for sleep disturbance.
Zyprexa (Olanzapine): Original use with schizophrenia. Used with older persons for anxiety, paranoia, agitation, aggressive behavior or mood stabilization.
For information on medications or drug interactions, click on the sites below.
- http://www.drugs.com/drug_interactions.html
- http://medlineplus.gov/
- http://mayoclinic.com/health/drug-information/DrugHerbIndex
- http://www.medscape.com/
