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My experience is practitioners push it like candy or say it’s extremely dangerous in the elderly. It accumulates in the body and can have increase in falls. My 88-year-old mother has difficulty with her mobility from arthritis and a spinal cord injury and cannot fully stand by herself, walks with a high walker. She has vascular dementia and difficulty sleeping, and anxiety. Have tried multiple drugs (melatonin, trazodone, and currently Seroquel) work at first, but then stop working or she has bad side effects. Currently have been suggested Abilify and risperidone. Any feedback would be extremely helpful ,thank you so much.

Here is a reference for an excellent article--it's designed for health care professionals but is pretty readable--from the Mayo Clinic--about benzodiazepines in the elderly. Clicking on the URL gets you to the full article:

https://www.mayoclinicproceedings.org/article/S0025-6196(16)30509-2/pdf
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Reply to Igloocar
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I honestly think it’s a trial and error game because we don’t understand much about how these drugs work nor about how dementia works in the brain.

My dad was diagnosed with bvFTD but his neurologist said his brain atrophy was consistent with several different kinds of dementia including vascular. He was originally prescribed benzos for his dangerous and very problematic behavioral problems. The two different kinds of benzos we tried (one, then another) actually made him much WORSE in different ways. One turned him into a maniac, the other into a non communicative zombie walking into walls. What worked best for him was Seroquel plus Trazodone for sleep. The dosages changed a lot over the 4 years he took them. When his obsessive behaviors increased, the Seroquel was increased. When his physical condition deteriorated and he lost strength, the Seroquel was decreased. I have not heard of Seroquel “stopping to work” but you know your mom best. Good luck!!
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Reply to Suzy23
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Kaysmile10, I am reading some other answers and your updates and responses.

You mention leg spasms in one of your responses.

This made me think of the "miracle drug" I have now used for my husband for about 5 years.
We started using Trazodone to calm his anxiety and help him sleep at night.
I found, as a happy side effect, his regular leg tremors stopped.
It seems to relax the whole body.
It is relatively safe, non-addictive, and can be tolerated in larger doses than you really need. Ask the doctor about it.
Of course, everyone responds differently to medications, so it may take a few trials before you find what is effective for your needs.
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Reply to CaringWifeAZ
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We found 400 mg of magnesium glycinate helped reduce anxiety.

Mom's PCP would not prescribe benzos as they are linked to falls.

They are also linked to causing dementia.
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LoopyLoo Jul 22, 2024
What studies have been done to prove they’re known to cause dementia?
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Xanax, which is a benzodiazepine, can be very effective in calming anxiety.
One thing to keep in mind with drugs like this, the patient can develop a tolerance, meaning the dosage may need to be increased over time, and they may develop withdrawal symptoms (more anxiety) when a dose is missed. That would be with regular, daily use. Occasional use can be pretty effective.

The drugs you mention, Abilify and risperidone are Not benzodiazapines, but antipsychotic medications. They can cause a side effect called tardive dyskenesia, or involuntary movements. And this class of drugs is not indicated for elderly dementia patients.
My husband with vascular dementia was prescribed risperidone, and developed the uncontrollable movements, and otherwise no noticeable effect on his mood or calming of anxiety. After stopping this drug, it took at least 6 months before the involuntary movements went away. One was moving his head from side to side. Try looking at something and moving your head from side to side. It will make you dizzy and unable to focus! I can't imagine how uncomfortable that had to be for him!
Yes, I would give the benzodiazepines a try. But I would not recommend antipsychotics for her condition.
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Gabapentin can cause dizziness and falls and should be used with caution in the elderly. Please don't combine that with a benzo.
If you decide to go that route, sounds like Valium would be the best. Shorter half life, can help with muscle spasms and other spinal problems.
Each patient reacts differently and the only way to tell would be to experiment.
The thing to watch for is that she doesn't end up on a drug cocktail with three or four or five different drugs. Be cautious.
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I don't have experience, with aging people on Xanax

But I'm going to share my experience with it.

We were having a very difficult time with one of my sons. Doctor put me on antidepressants and gave me ten Xanax. He was very careful to not get me addicted.

So anyways, my son burnt a hole abandoned mill down accidentally.
I'm sure you can understand that I was quite a mess.

So I took one Xanax, I literally felt so much at peace. I can tell you I never took another, because I new right then that I liked it, too much.

And I also know that if I'm ever in your moms position, I'd want Xanax.

I hope that was helpful to you.
Best of luck, so sorry about your mom
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Reply to Anxietynacy
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My father has Alzheimer’s disease so I don’t know if my experience with him will translate to your mother. Nevertheless, the following has been working.

My father was diagnosed with Alzheimer’s over 10 years ago, and he is now in the later stages of the disease. He tends to experience agitation and aggression more than anxiety. He also previously exhibited sleeplessness and nighttime wandering.

Seroquel, 50 mg, and melatonin pretty much solved the sleep disturbances. Xanax, .25 mg, as needed resolved most of the agitation/aggressiveness issues.

When my father was first prescribed Xanax, I gave him half pills. .25 mg is the lowest dosage, so he was getting 1/2 of the lowest dosage. As he has built up a tolerance, I have had to start giving him whole pills, but he is still at the .25 mg level.

I have never given him the Xanax on a regular schedule. Instead, I only administer when needed. I’ve learned to identify cues for when his agitation is about to start and give him the Xanax preemptively. Usually by the time the agitation starts, the Xanax has begun to take effect and he will calm down shortly. It should be noted that my father has 24-7 care. He is monitored all the time, even when he is asleep, with cameras and pressure alarms.

At the low dose my father is on, I’ve never seen him “high” or unstable. He does have some balance/walking issues unrelated to the medication but, as mentioned above, he always has someone around to help him ambulate.

Some of my extended family members were initially critical of me choosing to give him Xanax. Indeed, I even had one who told me that I did not need to “drug him up just so you don’t have to deal with him.” After observing my father on the Xanax, she realized that I was not drugging him up and the only effect was that he calmed down.

Benzodiazepines have a bad reputation because they can be abused. Nevertheless, it has been my experience that if they are given at a low dose, only when needed, they can be extremely effective in reducing agitation and aggression.

Also, others have said, you have to try different methods until you find what works. Further, you should be prepared to adjust over time as things change (ie., what works now may not work later).
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Kaysmile10: Per Google, "Long-term use can lead to dependence and withdrawal symptoms when discontinued. Benzodiazepines can impair cognition, mobility, and driving skills in older people, as well as increase the risk of falls. A recent study also found an association between benzodiazepine use in older people and increased risk of Alzheimer’s disease"

Yes, I know that your mother is not on a benzodiazepine; I am simply answeing your question.

Disclaimer: Not my authoring.
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Igloocar Jul 31, 2024
There is some actual literature about these questions; I have read some of it and will try to look for some specific references if I am requested to do so. However, as a former medical librarian, I urge you please to not use Google as a source of medical information! Citing info from "a recent study," which this quote does, unless there is a specific citation, can't be a trusted reference. Google itself is not peer-reviewed, so one doesn't know whether what it says is correct. To ger solid medical info in layperson's terms, go to medlineplus.gov.
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I think it's good to have a doctor who is willing to prescribe off label so long as they are also willing to admit when something isn't working and try again. For what it's worth my mom did very well on mirtazapine, it not only helped her sleep through the night it made her much more like herself during the day. I never notice any increase in appetite but for her that would have been a positive as well.
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Reply to cwillie
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Benzos were designed to allay anxiety and agitation, unlike Seroquel and Abilify (antipsychotics), trazadone (an antidepressant)or these other meds that fall into those categories and are far, far more likely to cause falls.

I would tell these practitioners that at 88, addiction isn’t a realistic concern.
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Kaysmile10 Jul 18, 2024
Thanks for your response. The concern is not addiction. The concern is falls as my mother has a spinal cord injury on top of her dementia. She fell in October 2020 and is an incomplete C6 fracture, came home in a Hoyer lift. We rehabilitated her to the point of where she is today. She cannot get up herself. She needs someone to help her with a gate belt to fully stand. She has right leg, spasms and neuropathy in her hands and feet and throughout her body from her spinal cord injury. Therefore practitioners feel that a non-benzodiazepine medication is better for her. Some have talked about benzodiazepines and I’m looking for people experience with them thank you so much for your response.
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None of the drugs you mention are benzos. So they aren't even in play right now.

Benzos can help a great deal with agitation, anger, anxiety and the like. Used appropriately, they can be wonderful mood stabilizers.

MOST people on Hospice (which you don't mention) have a cocktail of a benzo, or two and something for pain. Yes, you have to monitor the patient, but used in the proper dosage, can relieve the anxiety that is so often accompnying the aging process.

And some benzos (such as Klonopin) are considered to be quite 'clean'. They enter the bloodstream and do their job, then slowly exit, without the crash and burn of some of the other benzos.

Yep, it takes a bit to find what works. But right now, your LO is taking and OTC med (melatonin) and an old tricyclic AD (trazadone) and Seroquel, which can be super sedating.

A low dose of a real benzo may be helpful--but as always, check with the Dr.
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Kaysmile10 Jul 18, 2024
Thank you for your response. In the past, we have tried multiple medication’s of some that I had listed currently My mother is on Seroquel , cymbalta and gabapentin. You are correct she is not on a benzodiazepine, although some practitioners want to put her on one. Some say it’s lethal in the elderly in particular with my mother who cannot get up by herself and has nerve burning and muscle weakness from her spinal cord injury.
i’m looking for peoples experience with benzodiazepines. Also, if there’s other combinations of drugs that have worked besides benzodiazepines would be very helpful.
yes, if indeed she was put on a benzodiazepine, she would be need close monitoring by practitioner. Healthcare ,the way it is today there is not close monitoring of anything for anyone.
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I was once doing rounds in a hospital and my student asked about Valium. The chief resident responded that in critically I'll elderly, the benzos have a high mortality rate. They sometimes are given as a last ditch effort
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I’m an 85 year old retired RN with a Master’s in Adult Health. This is a difficult situation for everyone. There are criteria for nursing homes that limit the use of sedation for the elderly and yet so many other meds do not work. I think Lealonnie1’s " Figure out what meds work, and what meds don't, and go from there.” is spot on. Close monitoring of the patient is essential. And this sounds harsh and yet it’s true…they will fall and they will die and we should make them as comfortable as possible.
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Reply to jwellingtoncat
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Valium will help with sleep . Stay away from Xanax - very addictive and also terrible withdrawal if you Miss a dose .
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Ticabelle Jul 18, 2024
I’ve been taking a low dose of Xanax
for decades. It helps with anxiety. I was away and ran out of Xanax. It was 4 days until I got home to take a dose. I had no withdrawal symptoms other than being a bit anxious. Missing a dose will not put a person in withdrawal.
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Ativan helped my mother (with vascular dementia) deal with her anxiety and Sundowning quite a bit. She fell all the time anyway because she forgot she couldn't walk, but managed to live to 95. Imo, the main goal with dementia is to keep them calm and anxiety free as much as possible, not to extend their lives to 100. Nobody wins with dementia. It's a horrible disease where everyone loses and there's no relief until the elder passes. Figure out what meds work, and what meds don't, and go from there. Wellbutrin mom tolerated well, and Ativan.

Good luck to you.
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Onthehill Jul 18, 2024
Totally agree. My mom is at 90 right now. The doctor had her on BP meds, statins which she no longer takes. The interesting thing is that every time I take her BP it’s been excellent. Like 110/69, 115/68 in recent readings. Her sundowning is so bad our objective is keeping her calm and comfortable as possible at this point. Lexapro works very well for the constant crying and suicidal ideation. We use a Xanax in the evening and in the morning 5mg of THC (cannabis) legal in CA and her Dr. is aware. Works like a charm. She giggles, is happy, perks her appetite.
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