The use of antipsychotics in geriatrics has been under scrutiny from the Centers for Medicare and Medicaid Services (CMS) for several years now. The use of antipsychotics in older adults poses a myriad of complications and side effects. Side effects include increased incontinence, weight loss, lethargy, confusion and increased incidence of falls. While antipsychotics can be used for the treatment of mental and behavioral issues, antipsychotics should always be the absolute last resort in the geriatric population.

Determine Root Cause of Behavior Before Medicating

In the long-term, post-acute care (LTPAC) setting, we as caregivers have interaction with dementia residents on a daily basis. We also encounter numerous behaviors on any given day. As clinicians we try non-pharmacological interventions first at the onset of behaviors. If we are unsuccessful then we will medicate the resident. What are we missing? Why did the behavior happen to begin with? We have an obligation to our residents to understand the behaviors by digging deeper to determine the root cause. Educate your staff about how to approach everyday tasks for residents with dementia.

Educate Your Staff

Try a guided meditation, like this one:

Picture this - you are a dementia resident on a secured dementia unit. You are wearing your favorite wool sweater and have a lap blanket because you get cold easily.  You are confined to a wheelchair because of the severe arthritis in your hips and knees. Lunch has just finished and you are now dozing in the dayroom in your wheelchair. There is big band music playing in the background and the sun is shining on you through a nearby window. You are feeling full from lunch, safe, sleepy, content and warm.  All of the sudden you are jolted awake by the sudden movement of your wheelchair and you are being briskly pushed down the hall. You have no idea who is pushing you or where you are going. Your eyes close tightly because the sudden movement has left you a bit disoriented. You start to shiver as the air passes by you. You feel a bump as you turn abruptly into a room.  The door slams open hitting the wall behind it and you tentatively open your eyes. You find yourself in a cold, bright, tiled room. From behind you hear a voice that states, “OK, time for a shower!”  You then feel someone reach around you and take your glasses and the room becomes blurry.  You then feel someone next to you, but you cannot make out the indistinct, shadowy figure. The unknown person starts to remove your nice cozy sweater and shirt at the same time, quite hurriedly. They then turn on the shower faucet and the freezing overspray sprinkles your torso, arms, and face.  You then feel a hand grab the back of your pants and say “OK, time to stand up.” As you stand up your pants are quickly lowered to the floor. You are then told to turn and sit down.  You then sit in a cold and hard apparatus, causing you to shiver and get goosebumps. They brusquely remove your pants from around your ankles as well as your shoes and socks. The cold tile is now under your bare feet.  The frigid air seems to engulf you from every angle. You are now scared, anxious, uneasy, restless, confused, trembling, and naked… in the room with a stranger.  How would you feel?  What would you do?  What are you thinking?  What would your reaction be? Would you cry, yell, retract into the fetal position, strike out, or even try to bite someone?  We have an obligation to our residents to do better!

The next time you are providing care to a resident with dementia, put yourself in their shoes for a moment. Think about how you would want to be treated. Introduce yourself. Take the time to explain things before you do them. Offer compassion and dignity when providing care. Try to understand the reason for their actions/behaviors you are seeing. Don’t give medications for behaviors without investigating the underlying cause.

Fix the issue so that you do not have to continue medicating residents. This will keep your facility in compliance, will help your residents feel safe, secure and happy and ultimately will help your staff feel good about the great care they deliver.