We don’t have to duplicate Britain’s National Health Service and their 'Health and Well-Being Boards', but elders would be so much better served in the U.S. if we could work toward earlier screening and coordinated care for dementia patients.
Please join us in San Mateo on Thursday, September 11th for an important talk about early dementia and financial challenges. How would dementia affect your family’s wealth? What happens if an elder starts giving money away to anyone who asks? What if they start gambling and can’t seem to stop? What are the risk factors in not planning financial safeguards? How does elder financial abuse happen- and how prevalent is it? These and many other questions will be discussed with Dr. Landsverk and Certified Financial Planner Ben Pettigrew in an interactive discussion.• 12:00-2:00 • Lunch provided by Les Koonce and Ben Pettigrew of LPL Financial -Contact Adrienne Galvez at (650) 321-6068 or Adrienne.email@example.com
Location: Franklin Templeton Investment Headquarters at One Franklin Parkway, San Mateo, Building 920, First Floor, H.L. Jamison Auditorium
Almost nothing in my practice drives me more nuts than the relaxed attitude both our society and our medical establishment have toward prescribing sleeping pills and tranquilizers to elders, especially to elders with dementia. As I travel around the San Francisco Bay Area doing house calls and treating people with complicated dementia cases, I often find that my new patients have been treated with sleeping pills or tranquilizers. Sleeping pills like Ambien or tranquilizers of the “benzodiazepine” class— Lorazepam/Ativan, Alprazolam/Xanax, Triazolam/Halcion, or Clonazepam/Klonopin, to name just a few, there are dozens of brand names—can often cause more troubles than they solve in elders with dementia. Yes, these drugs do give temporary relief, but the price is often long-term problems.
It’s very common for elders with dementia to have disturbed sleep patterns. Many of my patients would love to sleep all day and stay up all night. But giving a dementia patient a sleeping pill very often makes them much more confused. A much better strategy is to wake the patient during the day when they try to nap. Find activities the elder will enjoy, and then encourage these pleasurable things. Keep an elder’s interest and engagement up will keep them awake during the day and help them to sleep at night. In general, I find that sleeping pills often worsen the symptoms of dementia.
As I’ve described in recent posts, dementia patients often suffer from severe anxiety and delusions. There are times when it’s appropriate to use an anti-anxiety medication for a quick result. Let’s say you’re trying to make it possible for an elder to tolerate a medical procedure, then a tranquilizer might be in order. Or, let’s say an elder has suddenly gotten completely out of control at their residence. If they’re lashing out, screaming and hitting people, a tranquilizer may alleviate the emergency of the moment. But as soon as the chaos is calmed, I always try to get my patients off tranquilizers as soon as possible.
In dementia patients, I have found that prescribing tranquilizers long-term often makes a patient situation worse. Rather than alleviating anxiety or confusion, it often makes those problems more severe in dementia patients. Paradoxically, tranquilizers will make some patients more agitated, not less. I have even had patients who became psychotic on tranquilizers.
Not only this, but tranquilizers are famously addictive. It can be difficult to taper down these medicines once a dementia patient gets used to them. If you discontinue these drugs too quickly, they can cause delirium. Often, I encounter cases where the delirium is blamed on the dementia, but usually the tranquilizers are to blame.
If your elder is on sleeping pills or tranquilizers long-term, those drugs may be the problem, not the solution. Check out our medication section on the ElderConsult website. Then starting asking questions
No, I’m afraid that you can’t. As I stated in my previous post, we as a society cling to the idea that dementia is simply a gradual fading out, a progressive loss of memories and self-awareness. While that’s not exactly comforting, it’s less disturbing than many of the cases that I see every day:
Confused elders whose illness has made them so anxious that they live in a state of constant terror.
Elders whose disease has made them dangerously paranoid, unable to trust anyone, convinced that everyone is trying to hurt them or kill them.
Elders who hit and bite and kick anyone who comes close to them, making it next to impossible to care for them properly.
Elders whose dementia has erased all their inhibitions, making them hypersexual. These elders make inappropriate comments. They may grope passers-by. They may make advances on caregivers, family members, you name it.
Elders who run away, again and again. They slip out through doors. They climb out of windows. They scale fences. They may wander miles and miles, for hours, sometimes even days. Each moment that they are out on their own they are in danger: of being hit by a car, of being abused, of being robbed, of experiencing a health emergency because they aren’t taking their medications.
Elders whose dementia has changed their brains in such a way that they feel an overwhelming need to engage in repetitive behaviors: They may swing their arms. They may walk constantly. They may cry out endlessly, even though there’s nothing wrong. They may ask the same questions over and over and over, or make the same statements, driving everyone around them a bit crazy.
While sometimes these behaviors start gradually, it’s common for them to begin at the snap of a finger. I believe it’s likely that this results from the physiology of many kinds of dementia. Alzheimer’s seems to be related to the build up of “plaques” that interfere with the signals between neurons in the brain. But there’s also vascular dementia—which can result from many mini strokes in the brain. There’s alcoholic dementia, which results from the damage of drinking too much. There’s dementia that results from other conditions like Parkinson’s disease. Sometimes, one of these maladies will just take out an important bit of the brain tissue, and suddenly you’ve got a behavior problem.
It can happen overnight. I’ve had patients who were charming and kind one day, then nasty and mean the next. A patient might be calm, then suddenly become inconsolably terrified or anxious. A patient may have a fairly solid grasp on reality, then suddenly come to believe that a devoted caregiver is trying to steal everything in the house, or that the hospital has been taken over by Nazis, or aliens, or unseen monsters.
Why do I think this is so important to point out? Because I believe that we all need to recognize that dementia is a dynamic, ever changing, malady. As healthcare professionals, family members and caregivers, we need to constantly be alert to changes in a patient’s behavior. We need to be willing to adjust our approach to dementia patients accordingly. We need to think nimbly, changing both behavioral and medical strategies as needed.
Dementia care is not a “set it and forget it” enterprise. It’s a day-by-day challenge. We all need to remember that.
Elizabeth Landsverk, MD
Board Certified in Geriatrics, Internal and Palliative Care Medicines House calls throughout the San Francisco Bay Area