Summer Sale Extended! Get unlimited digital access for 13 weeks for $13.
Readers Respond
News Opinion Readers Respond

Government right to push for reduced use of antipsychotics for dementia patients

Behavioral and psychiatric symptoms, such as depression, delusions, hallucinations, yelling, wandering and aggression, affect 80-90 percent of individuals with dementia at some point during the course of their illness. For the vast majority of individuals with dementia, these troubling symptoms are short-lived and can be successfully managed by caregivers who use behavioral modifications and non-pharmacological interventions such as reassurance, social activities to relieve boredom or agitation, reminiscence, and exercise.

The Centers for Medicare and Medicaid Services (CMS) use of policy efforts to reduce the inappropriate use of antipsychotics among dementia patients in nursing homes should be applauded. However, we must be careful not to demonize all use of these medications.

As indicated in the oped by Dr. Cheryl Phillips, ("The false promise of dementia drugs," Aug. 13), there are no medications, including antipsychotics, that are approved by the Food and Drug Administration for treatment of behavioral and psychiatric symptoms of dementia. There is modest evidence in the medical literature to support the short term use of antipsychotics among a small percentage of individuals with dementia who have persistent and distressing psychotic symptoms or physically aggressive symptoms that pose a significant danger to themselves or others. Before and during the use of any medication to impact symptoms of dementia, behavioral approaches should be used, informed discussions with the individual and family about risks and benefits should occur, and ongoing monitoring for effectiveness and side effects should be present.

Safe reductions in the use of antipsychotics can occur only when family and professional caregivers have access to education and coaching on the use of effective non-pharmacological alternatives. While there is some evidence about the effectiveness of behavioral interventions, results vary, and the use of these techniques is not a one size fits all approach. Obtaining the financial resources to test behavioral interventions in real world settings is challenging and clinical improvements are often modest at best. Knowledge of the person with dementia, the promotion of physical activity, and trial and error are often our best teachers when using behavioral approaches.

If we are serious about improving the behavioral health of individuals with dementia, we must devote time and resources to caregivers who face the daily challenges of understanding and managing behavioral symptoms. We must also reserve the option for appropriate short term use of pharmacological interventions when symptoms are severe enough to warrant their use.

Elizabeth Galik, Baltimore

The writer is an assistant professor at the University of Maryland School of Nursing.

Copyright © 2015, The Baltimore Sun
Related Content
  • Dirt bikers aren't the only danger on two wheels

    Dirt bikers aren't the only danger on two wheels

    The dirt bikers aren't Baltimore's only problem ("A '12 O'Clock Boys' theme park for Baltimore," Aug. 27). There are dangers from some other motorcyclists who display their "skills" on the Jones Falls Expressway, generally late at night or at 2 in the morning. Some of these cyclists must picture...

  • Think the Red Line is expensive? What about all those cars?

    Think the Red Line is expensive? What about all those cars?

    Ben Groff very articulately expressed many of the same sentiments I have about the Red Line and transit in general ("Why killing the Red Line was a mistake," Aug. 25). His emphasis on the negative aspects on car-based transportation is especially significant. I would add that the apparent convenience...

  • Shouldn't we read the Iran deal before supporting it?

    Shouldn't we read the Iran deal before supporting it?

    I find it un-American that your paper and many in Congress can apparently make a decision to agree with the proposed Iran nuclear deal without reading it or knowing what the side agreements the UN made contain. You are all taking the word of people that have a record of distorting the facts or...

  • Why not just give Iran the bomb?

    Why not just give Iran the bomb?

    I have a great idea for an update to the Iran deal that would save a lot of time. We should go ahead and provide Iran with nuclear weapons and also some ICBMs. This will substantially shorten the time necessary for them to develop or purchase them on their own.

  • No more riots, please

    No more riots, please

    Wow. City "leaders" getting ready for protests (also known as riots), thanks for the "heads up" ("City readies for protests," Aug. 27). It's time the law-abiding, taxpaying citizens of Baltimore say loud and clear: "Enough!"

  • Don't coddle dirt-bikers

    Don't coddle dirt-bikers

    I find it amazing that the illegal dirt bikers will probably have a place to ride some day ("City should have zero tolerance for dirt-bikes," Aug. 27). If it is illegal, how will they get to the area that will be provided without riding on the city streets? I guess it will soon be OK for me to...

Comments
Loading
72°