Dementia and Behaviors: To Medicate or Not To Medicate?
“I think my dad is over medicated, what do you think?” I get this question a lot. Especially now as there have been so many reports on the over medicating of older adults. Currently, there is no approved psychotropic medication for older adults, which scares families even more. I am not a medical doctor but I do recognize that medications have their place in treating the symptoms of dementia. As a Gerontologist, I choose to focus on Nonpharmacological treatments for problematic behaviors in someone with dementia. However, there are times that I highly recommend consulting a psychiatrist.
But when can you tell when Nonpharmacological interventions or pharmacological interventions are best? I look for a few things. The biggest thing is the level of harm the behavior causes, but even with this, there is a certain way to look at it, depending on the behaviors. Here are some common behaviors we see with someone with dementia:
- Refusal to eat
- Refusal to bathe
- Hyper Sexuality/Public Masturbating
- Exit seeking
Many of these are common but are not “problem behaviors.” A behavior is problematic when it is harmful to the person performing the behavior or someone else.
Before determining when a behavior becomes problematic, I look at several factors. Here are a few:
- Is something physical going on?
- Is the person hungry?
- Do they have mouth pain?
- Do they appear ill- check for fever.
- Is it a Urinary Tract Infection?
- Have they been around someone who had a cold, flu, or other illness?
- When was their last bowel movement?
- Are they thirsty?
- Do they need to use the bathroom? (I once had a client who refused bathing in the morning. So the caregivers just gave up. We tried different times but eventually figured out, if the client had an opportunity to use the bathroom first, they had no problem with bathing after the fact.— there is a phrase about this. Do you know it?)
- Is it the physical environment?
- Patterns on the wall or floors
- Colors of the surroundings
- Is the environment comforting?
- Is it the right temperature?
- Is it private enough?
- Is the lighting appropriate with minimal shadows?
- Is there a glare?
- Is it our approach?
- Did we spend time connecting?
- The pitch and tone of our voice.
- The body language we’re using
- Are we validating the persons feelings?
- Is there something we can redirect their attention to?
- Are there too many people in the room?
While these are just some examples of what we look for, it often takes a second set of eyes to determine the problem. One of my favorite ways to help communities is to offer another set of eyes. When I was the director of a dementia unit, I was sometimes too close to the situation to see the flaws in the environment or approach. But when someone pointed out “The sun is in his eyes,” or “He looks uncomfortable when he is standing on the hard floor.” It was so helpful!
The other factor I consider is if the person is experiencing psychological distress. Are they showing signs of anxiety, depression, obsessive compulsive disorder? I once had a resident who had such a strong urge to steal from others that she was walking on a broken hip. I kid you not! I have no idea how that is physically possible or how she could bear the pain, but she did it. This is obviously a problematic behavior.
My suggestion is to work with your whole team to problem solve. Ask caregivers who are not typically assigned to a resident to help solve the problem. Not only will this help you but it will also motivate and empower your team! When the behavior presents and immediate harm to the person performing the behavior or others, enlist the assistance of a psychiatrist sooner rather than later and work through some of the non pharmacological treatments after.
As always, do not use medications as a restraint. The medications should be used to improve the quality of life of the person with dementia, not sedate them.