Minding our Elders: Is dad’s Alzheimer’s worse or is he over-medicated?DEAR CAROL: My dad has been in a nursing home for two years because of Alzheimer’s disease and, until lately, we’d been happy with his care.
By: Carol Bradley Bursack, INFORUM
DEAR CAROL: My dad has been in a nursing home for two years because of Alzheimer’s disease and, until lately, we’d been happy with his care. About six months ago, the nursing home contracted with a different physician. Dad has become increasingly dizzy, confused and sluggish. I realize that Alzheimer’s can cause many symptoms, but I became suspicious of drug side effects so I asked to see his list of prescriptions. He’s now on more than 10 drugs, many of them prescribed by the new doctor. I’m wondering if these drugs are helping or hurting. How do I figure this out? – Jeff
DEAR JEFF: Your dad’s disease is progressive and in some cases it can be quite aggressive. That being said, it does sound like over-medication could be an issue. It’s unfortunate, but often busy doctors find that medicating for side effects of other medications is faster than looking for a different way to treat the patient. I want to be clear, however, that there are cases where the best care for the patient means that a doctor must order medication to make other necessary prescriptions more effective or less debilitating.
In a case like this, I’d first ask to talk with the prescribing physician and find out the reason for each medication. Even if the doctor gives a strong reason for each drug, I’d ask a pharmacist to run a check for interactions between all of the drugs. You may want to seek a second opinion from another doctor, as well. Even excellent doctors often have differing views on treatment.
Studies are consistently showing that people with Alzheimer’s disease frequently do better with fewer medications and increased hands-on, personal care. Most of the time, some medication is necessary, but generally the fewer drugs used, the better. Ask specifically if your dad is being given an antipsychotic drug. These drugs used to be prescribed routinely for dementia patients in many nursing homes.
Since it’s now widely acknowledged that the negative side effects of antipsychotics often outweigh any benefits that practice seems to be changing. Data released in July by the Centers for Medicare & Medicaid Services (CMS) shows a decline in nursing homes administering these drugs since CMS launched the National Partnership to Improve Dementia Care in 2012.
The Partnership aims to reduce the inappropriate use of antipsychotics in several ways. This effort includes enhanced training for nursing home providers and state surveyors, increased transparency by making antipsychotic drug use data by nursing homes available online at CMS Nursing Home Compare, and highlighting alternate strategies to improve dementia care. You may want to check the profile of your dad’s nursing home on www.medicare.gov/
nursinghomecompare to see how frequently they prescribe antipsychotics for their residents.
If you decide to consult a second doctor and both physicians agree that the drugs being given to your dad are necessary, you’ll likely feel better about the situation. If the doctors disagree, then you’ll have the information to talk frankly with the nursing home doctor and work with him or her to determine what types of treatment are in your dad’s best interest.
Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at firstname.lastname@example.org.