Alzheimer’s Care: Antipsychotic Medications

Some of the people you care for may be taking antipsychotic medications. These are meant to treat serious mental illnesses (SMI) like major depression, bipolar disorder, and schizophrenia. When the person also has Alzheimer’s disease, it is important that they remain on these medications to treat their mental illness.

Sometimes, however, antipsychotic medications are used with people who don’t have SMI but exhibit dementia-related behavior that is challenging for staff members. The problem is that this is an “off-label” or unintended use of these medications, and it may lead to dangerous side effects for the person such as excessive sleepiness, dizziness, unsteadiness, reduced wellbeing, social withdrawal, and sometimes even stroke. Moreover, many states actually consider antipsychotic medications to be a form of restraint.

If you notice any of these side effects, tell a nurse or your supervisor.

What Can You Do?

The question is, how do organizations and staff members deal with dementia-related behavior if they do not use antipsychotics? That’s where a person-centered approach like CARES® can make a big difference. CARES is an easy-to-learn approach that you can use in any situation and at any stage of Alzheimer’s disease or related dementias (ADRD), which often helps reduce behavior like repetitive questioning, “shadowing,” swearing, hitting, or biting. And when there is less dementia-related behavior, facility and agency medical staff may no longer need to prescribe as many antipsychotic medications.

By adopting person-centered strategies like the CARES® approach, caregivers can effectively manage dementia-related behaviors while reducing reliance on antipsychotic medications.

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Understanding Dementia Behavior as Communication

Understanding Behavior

Dementia changes how people think and understand their surroundings. As time goes on, it becomes harder for them to process and respond to the world around them. This can leave them feeling overwhelmed, confused, or scared. Their emotions and behavior are often ways of communicating how they feel. For example, in dementia communication can be challenging, as people living with dementia might not react well to the care you provide. They may repeat the same question, say unkind things, or become upset. In some cases, they may even hit, bite, or kick. These actions are not intentional or meant to cause harm—they are simply the person’s way of responding to their situation.

Every behavior is a form of communication, and this includes both challenging and positive behaviors. Understanding dementia behavior involves recognizing that while people with dementia may act out in frustration, they are also capable of smiling, laughing, holding your hand, or giving hugs. These are all ways they communicate, too. Taking the time to learn about the people you care for—their history, preferences, and needs—will help you better understand their behavior. It can also give you ideas on how to make them feel more comfortable, less anxious, and more at ease in their environment.

Behavior as Communication

The first thing you have to know is people with dementia aren’t trying to cause problems; they’re struggling to communicate due to their condition. in dementia communication often reflects pain, discomfort, or unmet needs. For example, a sore shoulder might lead to pushing or hitting when they can’t verbalize their pain. Behavior in dementia care should be seen as a form of communication, and it’s important to investigate causes, such as medical issues, environmental factors, or emotional needs. Addressing behavioral triggers in dementia, like overstimulation, loneliness, or boredom, can help alleviate challenges and improve their quality of life.

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Alzheimer’s Disease and Depression

The Alzheimer’s Association reports that many people with Alzheimer’s disease also experience depression, particularly in the early and middle stages. There is treatment available, it’s possible to improve a person’s quality of life by treating their depression.

Signs of Depression

How can you tell if someone you’re caring for is depressed? It can be tricky, as Alzheimer’s disease shares symptoms with depression. But there are some signs of depression in dementia that you should consider.

Common signs include:

• Loss of interest in activities and hobbies
• Withdrawal from friends and social activities
• Memory problems
• Trouble concentrating
• Sleeping too much or too little

As Alzheimer’s progresses it becomes more difficult for the person to identify and communicate feelings such as sadness, hopelessness, or loneliness. If you notice signs of depression, consult with the care team to reach out to their doctor.

Diagnosing Depression

Diagnosing depression in someone with Alzheimer’s disease is important but challenging. It involves a thorough evaluation, where doctors interact with the person, observe their behavior, and review reports from caregivers and other staff members. If you notice signs of depression, consult with someone on the care team to contact the person’s doctor.

Treating Depression

When a person with dementia is also depressed, seeking treatment is essential for improving their quality of life. Treatment options may include medication, counselling, and re-engaging with people or activities that bring them joy. It is not helpful to tell the person to “cheer up,” “snap out of it”, or “try harder.”

For more information about the diagnosis and treatment of depression in people with Alzheimer’s disease, please visit the free preview of CARES Dementa 5-Step Method at www.hcinteractive.com/5StepDemo.

Supporting individuals with Alzheimer’s who may also experience depression requires a compassionate approach.

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