The latest issue of the Journal of the American Geriatrics Society adds another nail to the coffin of antipsychotic drugs in older adults. In a Dutch study of nearly 23,000 people on these drugs, there was a 60% increase in pneumonia, compared with those not taking the medications.
Add this to the growing list of concerning reports about this class of drugs in recent years – they make Vioxx look good.
In nursing homes around the industrialized world, about 40% of people with dementia are taking antipsychotic drugs for behavioral symptoms of dementia. Looking at all of the published studies of drug effectiveness, even if you take the results at face value, fewer than one in five people show a clinical benefit.
If these were heart medications or antibiotics, we would have abandoned them long ago. We cling to them because of our narrow view of what elders with dementia need.
Antipsychotic use for dementia is dead – we just don’t know it yet! These drugs are the “physical restraints” of the 21st century. Thirty years ago, we couldn’t conceive of a safe way to untie people without causing greater harm, until some intrepid pioneers showed us the way. We were locked in the wrong paradigm.
And so it is with dementia. The problem lies in our approach to care. We create an institutional environment that favors tasks and interventions over relationships. We remove all aspects of autonomy and control. We try to force people with dementia to try and reorient their minds and bodies to the patterns of “normal” adults. Then we medicate the predictable result. (This happens in the community as well as the nursing home.)
Can we un-medicate people with dementia and have them live fuller, healthier lives? Absolutely! People are doing it as we speak, though their voices are still mostly out at “the fringe”. I’ll tell you how next Friday…
— Al Power