Approved assessment tools and clinical guidelines for psychopharmacy and early stage dementia in seniors?
Does anyone know if there are any approved assessment tools and clinical guidelines for psychopharmacy and early state dementia in seniors?
My understanding is that with this emerging field, most of the drugs are used off-label, many have black-box warnings, little evidenced based practice exists, as well as solid clinical studies to back it up.
The medications provided seems to be based on individual MD's preferences. My concern is some MD's are overprescribing, using aggressive cocktails of meds often knocking out or snowing the seniors so they default to placement into nursing homes vs. their own home. A family member who is not looking after the seniors best interest, may advocate for these meds as the family member is burned out, frustrated, and/or seeking other things like use the of the senior's home.
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I have had great good luck with several geriatric psychiatrists over the years after my mom was first diagnosed with Mild Cognitive Impairment and later dementia. There were 5 of them and ALL of them were thoughtful and cautious in their approaches, balancing patient comfort, safety and responsiveness. None aimed to "snow" my mother into oblivion.
Past the earliest stages, dementia patients need good supervision; this is especially true in a home environment with access to stoves, knives and other things that may be unsafe for their use.
The amount of man-power needed to keep a dementia patient at home is non cost effective for most folks.
My most recent LO weighed about 90 pounds when she entered residential care, and from her late Spring admission until she was placed in a locked Memory Care unit that Fall, she was painfully stressed, anxious, delusional…..nothing like the bull headed, vigorous dynamo she’d been before she’d become a chronic fall risk, living by herself in a house she adamantly refused to have adapted to what she needed.
When it became legally essential to have an assessment of her cognitive status, I asked the management of her residence if they could recommend a source, and I was promptly connected to a quiet, thoughtful examiner.
I sat behind LO while she was being questioned, and understood what was happening.
The examiner was able to reduce the single antidepressant she’d been taking, and ultimately added a second very small dose of a second medication, and for about a year, before COVID, she became more like her original self.
No question that dnajaras is on the right track about diagnosis and subsequent treatment.
I was vigilant and had enough training to do all I could to be sure LO was safe and well treated and that isn’t always the case. My LO deserved the best.
Have you accessed “…solid clinical studies…” to affirm that -
”…some MD’s are over prescribing…” “….often knocking out….”
”…snowing the seniors…”
”…default to placement into nursing homes…”
Have your personal investigations led to substantive research based facts about the assertions you’ve made?
Before retirement I worked in a field with an assessment component. In the span of time between receiving my degree and when I began active, hands on care of family members, there were some dramatic changes in therapy diagnosis and technique.
I saw some things that I personally believed were questionable practices, but as my personal and professional interest grew in the field, I observed very few instances of casual disregard by professionals in decision making positions.
What percentage of all of the geriatric care cases you’ve observed were overprescribed “using aggressive cocktails of meds”?
What realistic recommendations would you make to help encourage more family participation in geriatric client care?
How many geriatric cases have you overseen?
I am in absolute, total agreement with what I think may be your bottom line, and certainly objective assessment of the complex failures that inhabit behavior of the dementia patient are difficult, but have you the “evidence” to generalize as broadly as you are here?
I am blessed to live in a major metropolitan area; my mom had good insurance and had well-trained professionals guiding us and prescribing for her.
There are parts of the US that have few psychiatrists and even fewer who have any experience in geriatrics.
Thus, your mileage may vary.