People with dementia frequently exhibit responsive behaviors, which are often misinterpreted as aggression, resistance to care and challenging or disruptive behaviours. In such instances antipsychotic medicines are regularly prescribed. The benefit of these drugs is limited, however, and they can also cause serious harm including premature death. Their use should be limited to cases where non-pharmacologic measures have failed and where patients pose an imminent threat to themselves or others. Identifying and addressing the causes of behaviour change can render drug treatment unnecessary. If a nurse caring for a patient feels that medication is not the appropriate intervention, the nurse has a responsibility to discuss these concerns with the prescriber.
Sources:
Alberta Health Services. Appropriate use of antipsychotics (AUA) toolkit [Internet]. 2013 [cited 2016 Oct 19].
Brodaty H, et al. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. Am J Psychiatry. 2012 Sep;169(9):946-53. PMID: 22952073.
Choosing Wisely Canada. Canadian Geriatrics Society: Five things physicians and patients should question [Internet]. 2017 Jun [cited 2016 Oct 21].
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Gill SS, et al. Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study. BMJ. 2005 Feb 26;330(7489):445. PMID: 15668211.
Joller P, et al. Approach to inappropriate sexual behaviour in people with dementia. Can Fam Physician. 2013 Mar;59(3):255-60. PMID: 23486794.
Lee PE, et al. Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review. BMJ. 2004 Jul 10;329(7457):75. PMID: 15194601.
Registered Nurses’ Association of Ontario. Delirium, dementia, and depression in older adults: assessment and care [Internet]. 2016 Jul [cited 2016 Oct 19].
Rochon PA, et al. Antipsychotic therapy and short-term serious events in older adults with dementia. Arch Intern Med. 2008 May 26;168(10):1090-6. PMID: 18504337.
Schneider LS, et al. Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry. 2006 Mar;14(3):191-210. PMID: 16505124.
Seitz DP, et al. Efficacy and feasibility of nonpharmacological interventions for neuropsychiatric symptoms of dementia in long term care: a systematic review. J Am Med Dir Assoc. 2012 Jul;13(6):503-6.e2. PMID: 22342481.
Related Resources:
Patient Pamphlet: Treating Disruptive Behaviour in People with Dementia: Antipsychotic drugs are usually not the best choice
Toolkit: When Psychosis Isn’t the Diagnosis – A toolkit for reducing inappropriate use of antipsychotics in long-term care