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Thread: Medication may be last resort to ease patient's anxiety

  1. #1
    Super Moderator cougarnurse's Avatar
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    Medication may be last resort to ease patient's anxiety

    What do you think? http://www.vancouversun.com/health/M...096/story.html

    Sometimes medication is the only thing that will ease an Alzheimer patient's anxieties and agitation, a geriatric psychiatrist says.

    There are lots of different strategies that should be tried first, but if they don't work medication often helps, said Martha Donnelly, head of the geriatric psychiatry program at the University of B.C.

    Celexa, an antidepressant, is at the heart of the battle that may see Ellen Elliott, an 89-year-old Alzheimer's patient, forced to leave her long-term care facility.

    Ellen Elliott's daughter and legal guardian, Heather Elliot, has refused permission to medicate her mother, saying sedation is "a slow, quiet euthanasia."

    Her care home said Elliott needs the medication to alleviate her "constant agitation," to reduce her potential risk to other residents' safety and to ease her disrupted sleep patterns, a letter written by St. Jude Anglican Home's senior staff to Heather Elliott earlier this month says.

    Heather Elliott has been told to take her mother home by June 25, or they would admit her to the hospital.

    "It's a complicated problem. This is very difficult for families. It's a horrible illness," Donnelly said.

    Phyllis Dyck, a support and education coordinator for the Alzheimer Society, said it's crucial for families and caregivers to talk to each other about the patient, who often can't express what is bothering them.

    Agitation or anxiety in an Alzheimer's patient is always a response to something, Donnelly said. "You've got to look and see if there are any physical problems, such as pain, that's causing the response. You've got to look at the psychological issues - is there any continuing worry, are they depressed?

    "You've got to look at the social situation - is somebody else at the facility disturbing them? And you've got to look at the environmental issues - is there a noise or a smell that's bugging them?" Donnelly said.

    Failing that, calming techniques such as music therapy or warm milk to help the person sleep should be tried, Donnelly said. Families often know what comforts their family member, and they should let care-home staff know, Dyck said.

    Donnelly said she doesn't think Elliot was given medication to make life easier for the care home's staff.

    "I don't think it's [a matter of expediency] at all," Donnelly said. "If you don't sleep, it's not good. Bad things can happen. If you don't sleep at night, you tend to sleep in the daytime, but then you miss those activities that are meant to stimulate you and to help maintain you in function."

    Antidepressants are increasingly used to help Alzheimer's patients because they help reduce agitation when the cause is unknown, Donnelly said, adding that if one resident on a ward is agitated it can upset the other residents.

    "Oh boy, then you can have a cavalcade. It's not good for other people to have that, particularly when you have people up wandering at night and making noises," Donnelly said.

  2. #2
    Senior Member Grandma-RN's Avatar
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    Hummmm.....thanks for sharing.
    ER-RN

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  3. #3
    Senior Member suebird3's Avatar
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    I can understand not wanting polypharmacy, but....still and all, I think there has to be something else going on her. Cost? Having worked with many AD patients, the lowest dose of medication is started first. I am wondering how advanced the disease is at this point.

    There is a company called PESI (thanks, Cougar!) that has a Continuing Ed. class that deals with Challenging Geriatric Behaviours, and I learned alot from it. Yes, it mentions pain, lonliness, etc.

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