Advice for Caregivers: Dementia Medications

VNA Community Healthcare is a proud partner of Consumer Report’s Choosing Wisely Program, part of the ABIM Foundation.  We are committed to providing patient and family caregivers helpful and timely health information.

We know that if you are caring for an aging relative or friend, you want to help all you can. You may urge the doctors to try every possible treatment. But the experts who care for older adults say you should be cautious. Some tests and treatments won’t help older adults. They may even be harmful, especially near the end of life.

As seniors get close to the end of their lives, “quality of life” may be more important than living a little bit longer.  Here is one issue and a few tips to help you and your loved one make decisions about getting the best care.

Dementia—Antipsychotic Medicines
American Geriatrics Society, American Psychiatric Association, AMDA—The Society for Post-Acute and Long-Term Care Medicine

The problem: People with Alzheimer’s disease and other forms of dementia can become restless or aggressive. Doctors often treat these behaviors with strong antipsychotic drugs, such as aripiprazole (Abilify) and olanzapine (Zyprexa). But often the drugs don’t work. And they can cause side effects, such as:
Diabetes
Pneumonia
Stroke
Confusion
Reduced cognitive/thinking skills

Recommendations
Consider other causes of the behavior problem. Sometimes the cause is pain or an infection, or a hearing or vision problem.
Even if dementia is the cause, do not treat with antipsychotics first. First, try:
Other medicines, such as antidepressants
Daily exercise
More social or group time
When to use antipsychotics

The patient may need antipsychotics if you’re worried about the safety of the patient or others.

Dementia—Long-Term Medicines
American Geriatrics Society

The problem: To improve memory and thinking skills in people with dementia, doctors may use drugs such as donepezil (Aricept) and memantine (Namenda).

These drugs may help keep symptoms from getting worse, but the benefits are few, if any. And the drugs can cause side effects, such as nausea, vomiting, and loss of appetite.

Recommendations
Set clear goals for the drug treatment, such as more interaction with others.
If there is no improvement after 12 weeks, the medicine should be stopped.

Consumer Reports is working with the ABIM Foundation and Choosing Wisely partners, like VNA Community Healthcare to publish easy-to-understand resources for patients to understand the recommendations. With more than 50 patient-friendly pieces completed, the materials help explain the scientific basis for decisions, describe patient options and articulate the risks and benefits of respective tests, treatments and procedures so that patients can engage in an informed conversation with their physician.

For more information about Choosing Wisely visit www.ChoosingWisely.org.