condition where the brain function tends to reduce with age. The ability to do
things that were learned during the lifetime decline during the golden years.
This period is not only distressing for the patient but can be extremely
frustrating for the caregivers. Quite
often, the agitation and aggressive behavior of the patients is treated with
antipsychotic drugs, though they may not be officially approved for the purpose
Antipsychotic drugs include drugs like Olanzapine, Risperidone and
that are used to control psychotic symptoms like mania and
hallucinations in patients with bipolar disorder.
‘Dementia should be handled with a human touch and not only medications.’
use of antipsychotic drugs to treat agitation
in dementia patients who cannot communicate their needs may not the right
Researchers have suggested that the agitation in dementia patients may be an
expression of their needs that have not been addressed and should be approached
in the same way as one would approach a child. They introduced a program called
"OASIS" to train nursing staff to address the needs of dementia
patients with a more human approach. The program empowered the staff to
understand and fulfill the patients' requirements, rather than just drugging
them with antipsychotics. The staff was also encouraged to integrate the
strengths of the residents in the daily care plans.
To test the
effectiveness of their program, the researchers compared the use of off-label
antipsychotics in 93 nursing homes that were enrolled in the "OASIS"
program as compared to 831 homes that were not enrolled in the program.
researchers found that:
- The use of
off-label antipsychotics reduced by 7.6% in those homes that were enrolled
in the "OASIS" program over a period of nine months, while it
reduced by 3.9% in those homes that did not follow the program. The
program thus appears to have a positive impact in the approach towards
- The main decrease
in antipsychotic use was noted during the six-month implementation period
of the program, but was not sustained during the three-month maintenance
period following this phase.
- The patients did
not need additional psychotropic drugs or did not experience more
behavioral changes despite the reduced use of antipsychotic drugs.
Antipsychotic drugs are
associated with an increased incidence of stroke and death in the elderly.
Therefore, minimal use of these medications would definitely benefit this
population. References :
- Tjia J et al. Association of a Communication Training Program with Use of Antipsychotics in Nursing Homes. JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2017.0746