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dementia patients and sedation

Started 1338818284.957 in Viewpoints | Last reply 1338904205.343 by kdgn

There is an article on the front page of the Pittsburgh Post Gazette today saying that medicare & medicade have started an initiative to stop sedating agitated dementia patients. They feel that patients who are demented to the point of lashing out should instead have personal attention, exercise and music therapy.

UPMC, a huge hospital system here in W. Pa answered back that there is no way there is enough staff to spend one on one time with these patients and that these therapies do not actually work.

Personally, If I went in to visit my parent in a nursing home and she was all violent and agitated I would be way more upset than going in and seeing her sedated and calm. Also, if I were the patient I would rather be sedated than be being tormented by irrational thoughts.

Also, certainly,it is difficult enough to find people who are willing to care for demented patients let alone if they are going to come to work daily and be getting punched, kicked, spit on, urinated on and Lord only knows what else as these are the types of behaviors that cause patients to be sedated in the first place.Ii have seen nurses have handfuls of their hair pulled out and their uniforms ripped apart by agitated patients. I do understand that there are staff who do sometimes appear to over sedate and that can be brought up with the director of the home but to just out & out say no one should be sedated is - IMO - is obviously not being said by anyone who has actually been in the position of caring for demented patients.

First they said we can't restrain anyone so we had to get rid of things like geri chairs - a chair with a table across the front that kept the patient seated and gave them a place to eat or do something if they were able so now the patients wander around all day and frequently fall. Or, if they are in the hospital for medical care they are pulling out all the tubes and lines over and over. I'm not advocating over use of restarints or of overuse of sedation but there has to be a happy medium.

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happy hous­ewife1338828781.4728004 PostsRegistered 1/4/2007

I am bumping this up because I thinkit is something worthwhile discussing.

JuJu Squee­zy1338828922.6473362 PostsRegistered 11/1/2011

I will be glad to take all that sedation off their hands before it spoils.


straykatz1338829190.017829 PostsRegistered 6/13/2007

I've seen so much over sedation that it frustrates me to no end....but at the same time I feel sedation is better than the violent outbursts that not only endanger themselves but others too.

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happy hous­ewife133882970028004 PostsRegistered 1/4/2007
On 6/4/2012 straykatz said:

I've seen so much over sedation that it frustrates me to no end....but at the same time I feel sedation is better than the violent outbursts that not only endanger themselves but others too.


It is not that hard to sedate without oversedating.

Where i worked most of my career in ICU we had very strict rules about having to be able to arouse the patient and we were required to awaken them every 2 hours to check and be sure they were not oversedated, unless they were in an induced coma then we had a different protocol for being sure it wasn't too deep.

dreamytoo1338830001.271870 PostsRegistered 11/21/2007

My father nearly died due to careless over sedation! 3 1/2 years later for all we know that is what was done to him again causing his death last December. It can be very dangerous to sedate the elderly.

Restraints I have some different ideas on - here nursing homes are not allowed to even have full bed rails...they have only the top third - actually more like 1/4 of the bed. We are encouraged to use bed rails for our toddlers, but not the elderly??? We should not keep them safe from falls???

SUHSE391338830466.461443 PostsRegistered 3/13/2012

My Grandmother suffered with dementia/Alzheimers.

While she did recognize the people closest to her, until the very end, she also, later in her illness became the victim of terrible hallucinations, that were very real to her.

The family agreed to her being treated with anti-psychotic drugs. These drugs are not really intended for dementia, and pose an added risk to elderly dementia patients. Gran was in her late 80's at the time, and we could not bear to see her suffer with these hallucinations. It wasn't an easy decision to agree to these drugs, but they helped her so much. We never regretted our decision. The drugs gave her relief, but we never felt she was overmedicated.

happy hous­ewife1338831428.0128004 PostsRegistered 1/4/2007
On 6/4/2012 SUHSE39 said:

My Grandmother suffered with dementia/Alzheimers.

While she did recognize the people closest to her, until the very end, she also, later in her illness became the victim of terrible hallucinations, that were very real to her.

The family agreed to her being treated with anti-psychotic drugs. These drugs are not really intended for dementia, and pose an added risk to elderly dementia patients. Gran was in her late 80's at the time, and we could not bear to see her suffer with these hallucinations. It wasn't an easy decision to agree to these drugs, but they helped her so much. We never regretted our decision. The drugs gave her relief, but we never felt she was overmedicated.


Sometimes I would go into my Dad's room and he was hallucinating he was in France in WW11 and they were being shelled - he'd be screaming that the whole villiage was on fire. He was terrified. I would beg them to give him something to get him away from feeling like that. I think many elderly men hallucinate war experiences.

happy hous­ewife1338831792.37728004 PostsRegistered 1/4/2007

Honestly there is also the fact of staff being injured by these patients. I have had patients in DT's swing at me with the IV pole - I had a young patient who was an OD wake up during dialysis and when I told him he had not died and he was in ICU he sat up and hit me in the middle of my chest so hard he knocked me through the petition into the next room. He could have caused me to have a cardiac arrest by hitting me that hard in the chest. The staff, the other patients and the visitors have to be kept safe too. People think that old people are weak but when they are so afraid their adrenaline is pumping and they are very strong.

Shorty2U1338832069.14713834 PostsRegistered 6/24/2007

People are overly medicated so I agree with this new technique. Example which I hate to bring up because it makes me sick and sad...But. here goes..

When my dad was in the nursing home after a fall, he had slight dementia. (The stuff he was complaining about was legitimate complaints, as in he wasnt a threat at all). Well they sedated him. We HATED it. He wasnt his funny self and sat like a ZOMBIE, and we fought to get him on the lowest does possible. Anyway......

his sedation ended up in him sitting and staring and not acknowledging as much as he could how sick he REALLY was. I noticed the difference, and KNEW he was ill. He ultimately had kidney failure which ended up killing him because no one would listen to me when I said he was ill until it was TOO late. All they kept saying was DEMENTIA. Dementia. Dementia BALONEY. He was VERY SICK.

Conclusion I TOTALLY AGREE with NOT sedating patients UNLESS they are able to hurt someone or themselves. But if they cant get UP or have NO strength to do anything NO sedation. Music therapy and the other suggestions are MUCH better IMHO.

happy hous­ewife1338832780.428004 PostsRegistered 1/4/2007
On 6/4/2012 Shorty2U said:

People are overly medicated so I agree with this new technique. Example which I hate to bring up because it makes me sick and sad...But. here goes..

When my dad was in the nursing home after a fall, he had slight dementia. (The stuff he was complaining about was legitimate complaints, as in he wasnt a threat at all). Well they sedated him. We HATED it. He wasnt his funny self and sat like a ZOMBIE, and we fought to get him on the lowest does possible. Anyway......

his sedation ended up in him sitting and staring and not acknowledging as much as he could how sick he REALLY was. I noticed the difference, and KNEW he was ill. He ultimately had kidney failure which ended up killing him because no one would listen to me when I said he was ill until it was TOO late. All they kept saying was DEMENTIA. Dementia. Dementia BALONEY. He was VERY SICK.

Conclusion I TOTALLY AGREE with NOT sedating patients UNLESS they are able to hurt someone or themselves. But if they cant get UP or have NO strength to do anything NO sedation. Music therapy and the other suggestions are MUCH better IMHO.

I know states are different but in Pa. nurses have to document exactly what behavior they are sedating for. You can't just say pt was agitated and was given -----. You must say pt bit nurse and was kicking and pulling out his IV so Dr was called and ------ was given and then you must document every 2 hours what level of sedation he is at - for instance - patient was awakened and responded appropriately when spoken to. I think maybe some states need more regulation of how patients are sedated but to just say - no more sedation is ludicrous.
I worked in ICU and without sedation we could never have kept our tubes and lines in the patients. We also had to have every 24 hours orders to restrain pts and then we had to remove the restraints every 2 hours and document that was done. Often I would untie my patient's hands when the family was in the room and the goof balls would allow the patient to pull out the stuff while they were standing there.What were they thinking????

moonstone ­dunes1338832998.6431829 PostsRegistered 11/6/2011

My Dad had been a boxer when he was young. He was always defensive and much worse as he got older. When ALZ set in he became combative, with me and my Mom - throwing things, hitting and pushing. He became more and more difficult for my Mom to care for at home. We couldn't reason with him, he stayed in bed for 20 hours a day.

At the nursing home he had to be in restraints in bed and in the wheelchair, because he especially didn't like the male orderlies. He didn't know where he was. My Mom wouldn't ask to see the list of his meds but I did get a look once and one med listed was Risperidone. He also got trazodone at bedtime, but I think most of the patients took this.


"Sursum Corda"

kaybee1338836464.4478085 PostsRegistered 7/3/2006Wisconsin

We never had to medicate my non-verbal son until he hit puberty last year....well, we didn't start the meds until just 2 months ago but Risperidone is doing wonders for him. We couldn't leave the house last summer because I couldn't trust him.

The psychiatrist told us at his appointment a few days ago that patients that suffer with aggitation usually have the worst time starting around April up till the end of June (summer solstice?) and then level back off again by fall. That seemed to be true with my son last year.

Risperidone has it's own health risks also....one complication being diabetes.



Free2be1338836780.6339917 PostsRegistered 6/7/2006

Please go to the article at the Pittsburgh Post Gazette site. Type dementia in the search box and read the article.

It is not about stopping medications needed for agitation for dementia but about cutting back and why. Read the entire article.

sweetolivia1338838363.9972563 PostsRegistered 2/24/2012

My Dear Mother had dementia for the last 4 years of her life. Some days she know us other days she would ask me if she had children. We, her children, wanted her to have meds if she was very agitated. I did not want her to be in that state.

She was no longer the monther that I knew. If we sang together it was wonderful for me. I would not be selfish and deny her meds that would calm and soothe her. I wanted her to sleep at those times. She lived to be 95 and died 2 years ago. I miss her every day.

Meds used properly are a blessing.

15 year Breast Cancer Survivor

I am Woman Hear Me Roar!

beach music1338842401.53729065 PostsRegistered 4/16/2007
On 6/4/2012 Free2be said:

Please go to the article at the Pittsburgh Post Gazette site. Type dementia in the search box and read the article.

It is not about stopping medications needed for agitation for dementia but about cutting back and why. Read the entire article.

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annaboxer1338856513.157489 PostsRegistered 2/12/2009South Philly

My mother was a recent victim of over-sedation at her nursing home. She has FTD, which is a form of dementia that attacks the frontal lobe and has given her aphasia to boot. anyway, my sister and I had been complaining that she was too tired to even eat. After months of us suggesting she be given less Clonazapem, her regular cretakers also cmplained and stopped giving it to her. True, she can be combative at times, but over-sedation is not the answer. She is now much more lucid and will laugh at things, where as before, she was a lump in a wheelchair.

The care takers in nursing homes are trained to deal with the issues that accompany dementia and Alzheimers and are aware that it is the disease and not the real person who is lashing out. Agression can also be caused by pain, which if over-sedated, they would never be able to diagnose. Sorry to rembale on, but this is a topic close to my heart and I think many places over-sedate so they can ignore the troublesome patients.

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happy hous­ewife1338897101.58728004 PostsRegistered 1/4/2007

So, those who are anti sedation - how do you suggest that a combative patient be prevented from attacking other patients and the staff. Wouldn't you be terribly upset if you went to visit and found your loved one had been attacked by another pt or that your loved one had attacked another patient? Would you stay at a job where you were being routinely physically attacked by the patients?

kdgn1338904205.34312409 PostsRegistered 10/6/2004

I'm not so sure it's the nursing staff that over sedates with psychotropic meds. When my mother started becoming overly anxious to the point where the staff couldn't redirect her, a psychiatrist referral was made by her doctor. I spoke to the psychiatrist on the phone, explained what I had observed and requested something on a as needed basis. I specifically told him I didn't want her like a zombie. He said he never did that to his patients and his last words to me were that he was off to see my mom.

The next day I received a call that mom was in respiratory distress and on oxygen-and had been like a zombie all morning. Further investigation with the Director of Nursing showed that the psychiatrist had prescribed an anti-anxiety medication THREE times a day with a HIGHER dose as needed. Further investigation showed that he indicated he had spoken to me and I had approved this intervention!

If that psychiatrist had been there he would have found my hands around his throat. That was not what we had discussed, he expressly disregarded my request for medication on an as needed basis. Overly sedated? He could have killed her. The nursing staff had no choice but to give her the medicine as prescribed. I stopped that. The DON and I reworte the medication orders, her own doctor countersigned them. She was to be given a minimum dose only as needed. Period. I also left orders that the psychiatrist was never to see her again regardless of what the HMO said.

I see her medication log all the time. She gets the med less than once a month. I checked recently and she hasn't had it in three months.

eta: It is also the law that psychotropic drugs can not be given without the express written consent of whoever is in charge of medical care-as in Power of Attorney for Health Care. I have to sign the okay or approve over the phone. That's where the dr. got away with it initially by saying he had spoken with me and I approved. Wrong. We never discussed the medication nor the dosage, just that the need might be there.

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