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Antipsychotic Drugs Hasten Death In Dementia Patients


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Antipsychotic Drugs Hasten Death In Dementia Patients

 

http://www.forbes.com/sites/cjarlotta/2015/03/19/antipsychotic-drugs-hasten-death-in-dementia-patients/

 

 

Even though practitioners can prescribe several other medications for dementia patients, many physicians still resort to antipsychotics — despite the known increase of potentially damaging side effects. In fact, antipsychotics may actually speed up the dying process in dementia patients more than previously realized, a new study shows.

 

With the hopes of learning more about the harms associated with using antipsychotics in dementia patients, researchers from the University of Michigan Medical School and VA Center for Clinical Management Research pulled data from the VA national electronic health record system to analyze nearly 91,000 veterans over the age of 65 with dementia. They published their findings in the latest issue of the Journal of the American Medical Association (JAMA).

 

Dr. Donovan Maust, lead author of the study and assistant professor of Psychiatry at the University of Michigan, told Forbes that many people don’t realize the behavioral and psychological symptoms of dementia. These common symptoms include delusions, hallucinations, agitation and aggression. “These symptoms are very distressing to caregivers and are responsible for a significant amount of the cost associated with caring for patients with dementia,” Maust said. “These behaviors may be dangerous and place the patient at risk for harming themselves, their family and other caregivers.”

 

“The fact that antipsychotic use persists in spite of the evidence of harm speaks to both how problematic these behaviors are and that there are few other interventions available,” he added.

 

Alternatives to using antipsychotics for dementia patients include valproic acid, cholinesterase inhibitors and antidepressants. “Non-drug behavioral interventions are important alternatives, but they are generally time-intensive with limited mechanisms for reimbursement, so are not widely available,” Maust said.

 

The study found that patients taking antipsychotics may face a higher risk of mortality. Risk climbed along with dose in patients using newer, more commonly used antipsychotics. The reasoning for this, according to Maust, is unknown.

 

“One possibility is that a higher dose means patients are more sedated, which might lead to more falls or more aspiration,” he said. “In frail older patients, such events could ultimately hasten death.”

 

Patients in the study taking haloperidol had an increased mortality risk of 3.8% compared to matched nonusers. Those participants receiving quetiapine had an increased risk of death of 2.0%. Other tested antipsychotic drugs had fallen somewhere in between.

 

“The majority of antipsychotic use among older adults is off-label prescribing for the behavioral symptoms of dementia,” Maust said. “Use has been subject of a considerable amount of attention over the past decade, as safety concerns have become more evident, specifically in patients with dementia.”

 

Maust’s team believes in the “DICE” approach to assessing and managing behavioral systems in dementia, even though this tactic takes more time than writing a prescription. This approach focuses primarily on non-pharmacological strategies first, and it’s not taught in medical school or residency. It also requires support from policy-makers and alignment of reimbursement strategies.

 

“We hope that doctors can use the mortality risk estimate (and number needed to harm) as a part of their discussion with families to understand the risks of treatment,” Maust said. “In frail older patients, such events could ultimately hasten death.”

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Having spent a large part of my nursing career in geriatrics I can agree with what this article says. People who have never dealt with dementia do not realize just how violent these people can get. Drugging them into a stupor is the only treatment available. MM would be such a blessing to those people and their families. Nursing homes will never use MM with the present legal situation - instead they use antipsychotics by the handful - they don't have any other choice at the present time. The nursing staff caring for these patients know MM would be a much better treatment, but so much would have to change before it would be a viable treatment in those facilities.  Now at home that is a different story - the problem now is many of these families who would like to at least try MM don't know where to get it, and are afraid to go "online " to find a caregiver if they don't have family willing to grow for them. This is one reason I would like to see dispensaries - easier access for those type of patients.

 

Many dementia patients end up in nursing homes simply because the families can no longer handle the aggressive behaviors. MM would certainly  improve the lives of both these patients and their families in many cases

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Anti-psychotics is the latest off label hoax.  Like using epilepsy meds for pain relief.  It is nonsense.  They should all be ashamed of themselves and there are better options even ruling out Mmj.

 

 If these people weren't crazy with schizophrenia, they are now.  there are better depressants to use by a million miles. 

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 “Non-drug behavioral interventions are important alternatives, but they are generally time-intensive with limited mechanisms for reimbursement, so are not widely available,” Maust said.

 

 

 

 But that I means I have to actually work with patients! and corporate insurance oligarchs aren't willing to pay to actually take care of people.  Pump em full of completely ineffective drugs and stick em in a corner until they die.  Much better solution.

 

 

:horse:

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 But that I means I have to actually work with patients! and corporate insurance oligarchs aren't willing to pay to actually take care of people.  Pump em full of completely ineffective drugs and stick em in a corner until they die.  Much better solution.

 

 

:horse:

Yep staffing levels have been cut in half in just the last decade, its all about the money.

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