6 Things to Try Before Using Antipsychotic Medications for Dementia Behaviors

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Medication can’t always solve difficult dementia behaviors

When seniors with dementia have challenging behaviors like anxiety, aggression, agitation, or others, it’s exhausting and frustrating.

When you’re at the end of your rope, you might think that behavioral medication (usually antipsychotics) could solve the problem. This is a common misconception and unfortunately, it’s often not true.

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 share key points from the tip sheet that explain why AGS doesn’t recommend antipsychotic medications for dementia, suggest 6 things to try first, 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

6 things to try before using antipsychotic medications for dementia

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 your older adult 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 clearly 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, which 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 an exercise routine that improves dementia symptoms. Get more exercise routine suggestions

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. Here are tips on how to reduce resistance to care and how 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.

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.

This article is reprinted by permission from DailyCaring.com.


DailyCaring offers practical answers to the questions that family caregivers encounter every day as they care for their older adults. See full bio