6 Things to Try Before Using Antipsychotics for Dementia Behaviors

Medication can’t always solve difficult dementia behaviors

When someone with Alzheimer’s or dementia has challenging behaviors like aggression, anxiety, or agitation, it can be exhausting and frustrating for caregivers.

The first solution that comes to mind might be behavioral medication, usually antipsychotics.

Unfortunately, these medications are typically not helpful.

We found a handy tip sheet created by the American Geriatrics Society (AGS) and Choosing Wisely that explains why antipsychotic medications for dementia aren’t recommended as the first choice for treatment – the risks often outweigh the benefits.

We explain why the AGS doesn’t generally recommend antipsychotic medications for dementia, share 6 non-drug ways for how to handle dementia behaviors, and explain when antipsychotics should be considered.

Why antipsychotic medications for dementia aren’t recommended

1. Antipsychotic drugs don’t help much
According to the AGS, studies have found that antipsychotic drugs usually don’t reduce challenging behavior in older adults with dementia.

2. Antipsychotic drugs can cause serious side effects
Doctors may prescribe antipsychotic drugs “off-label” for use in treating dementia behaviors, but the FDA has not approved them for this purpose.

The side effects can be very serious and the FDA now requires the strongest warning labels on these drugs.

Side effects include:

• Drowsiness and confusion
• Increased falls
• Weight gain
• Diabetes
• Shaking or tremors (which can be permanent)
• Pneumonia
• Stroke
• Sudden death

 

How to handle dementia behaviors: 6 things to try

In most cases, it’s best to try other approaches before using antipsychotic medications to manage challenging dementia behaviors.

1. Get a thorough physical exam and medication review
Having their doctor give a thorough exam and full medication review is a good first step to figuring out the root cause of difficult behavior.

Because people with dementia can’t communicate discomfort or needs, these behaviors may have a physical cause like constipation, infection, chronic pain, vision or hearing problems, or sleep problems.

Plus, many common medication side effects and combinations of medicines (due to drug interactions) can cause added confusion and agitation in older adults. That could lead to challenging behaviors.

2. Stick to a regular daily routine
If your older adult is losing their cognitive abilities, their world gets filled with more and more unknowns.

If their days aren’t structured, life can become even more stressful because they may not know what to expect next.

Having a regular daily routine can reduce difficult behaviors, improve sleep, and reduce sundowning symptoms.

3. Help them exercise regularly
Regular exercise has many physical and mental benefits for all people, but can be especially helpful for older adults with dementia.

Exercise can slow cognitive decline, boost mood, burn off nervous energy, and improve sleep.

There’s even a home exercise routine that improves dementia symptoms. Get more exercise suggestions here.

4. Learn new communication skills
Something that’s less obvious is that we need to learn new ways to communicate with someone with dementia.

Their cognitive abilities are declining, which means that our “normal” methods may not work well anymore and could actually cause conflicts.

For example, certain natural actions may unintentionally cause your older adult to resist help.

Try these tips to make sure they’re not startled by your attempt to help.

Additional dementia communication tips:

• Agree and use therapeutic fibs to go along with their reality rather than correcting them
• Respond in ways that reduce repetitive questions before you get too frustrated
• Use short, direct sentences to make understanding easier
• Increase your ability to handle false accusations

5. Keep them entertained with engaging, no-fail activities
Boredom can also contribute to challenging behaviors. Everyone needs to have something to do and a way to have fun and feel successful.

Helping your older adult find activities that suit their current abilities and interests is a great way to boost their mood and self-esteem while reducing anxiety and agitation.

Some ideas:

• 10 Fun, No-Fail Activities for People with Dementia
• 6 Calming Ways to Help Seniors with Alzheimer’s Keep Hands Busy
• 6 Alzheimer’s Sensory Activities Reduce Anxiety without Medication
• Get more dementia activity ideas

6. Consider other types of medications

• Try FDA-approved medications for Alzheimer’s (that may also work for other dementias) to slow cognitive decline and reduce symptoms
• If your older adult could be depressed, treat with antidepressants

 

When antipsychotic medication may be needed

There may be situations where antipsychotic medications may be necessary.

• If other approaches haven’t worked
• Your older adult is severely distressed
• They could hurt themselves, you, or others

If an antipsychotic medication is used, use these tips for best results:

• Start at the lowest possible dose and increase a little bit at a time – the goal is to find the minimum necessary dose to keep behavior manageable
• Watch carefully to see if your older adult improves
• Watch carefully for side effects

If the medication isn’t working or causes side effects, let the doctor know right away so they can come up with an alternate plan. Don’t stop or change doses without doctor approval.

 

Next Step  Save or print the tip sheet on how to reduce and manage challenging dementia behaviors without antipsychotic drugs from the American Geriatrics Society and Choosing Wisely (PDF)

 

Recommended for you:

• How to Talk to Someone With Dementia: Calm, Positive Body Language
• How to Talk to Someone with Alzheimer’s: Short, Direct Sentences
• 9 Must-Read Alzheimer’s Books for Caregivers

 

By DailyCaring Editorial Team
Image: LifeCare Advocates

 

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