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Effects of Behavioral Medications
Care Assisted Living Facilities
By Diane Morrow, LNHA
The intention of the law is to allow for each person
to reach and maintain his/her highest possible state
of well being, in an environment that prohibits the use
of chemical restraints for discipline or staff convenience,
and limits chemical restraints use for dealing with circumstances
in which the resident has medical symptoms that warrant
the use. Psychoactive medications should only be used
when it can improve the resident’s quality of life.
Chemical restraints are not to be used to control resident’s
behavioral symptoms or as a substitute for individualized
care. Chemical restraints are only to be used as a last
resort to ensure the safety of the resident or other
- Medical Symptom is defined as
an indication or characteristic of a physical
or psychological condition.
- Chemical Restraintis defined
as any drug that is used for the primary or explicit
purpose of reducing an individual’s functional
capacity, and not required to treat medical symptoms
(including the resident’s medical or psychiatric
condition.) A drug used as a restraint is a medication
used to restrict the resident’s physical, mental,
or psychological functioning and is not a standard treatment
for the resident’s medical or psychiatric condition.
(Medicare’s Guide to Surveyors)
Before a psychoactive medication is used, the
permission of the resident and responsible party
must be obtained. See Psychoactive
The resident or the resident’s responsible
party, (on the resident’s behalf), have the right
to refuse any psychoactive medication. All admissions
to residential care assisted living facilities are on
a voluntary basis.
- “Psycho” pertains to
the soul or the mind.
- “Tropic” is derived from
Atropine. “Atropine” is an Alkaloid obtained
from Atropa Belladonna. (Interesting note Alkaloids
are Alkaline: Many health food followers believe an alkalizing
diet can help with reducing behavior problems)
- “Atropa Belladonna” is
made from “Deadly Nightshade”; the berry from
the tree can produce sedation, delirium, dilation of the
pupils, and even death.
- “Psychoactive Medications” also
grouped with Psychotropic, Psychotherapeutic, and Anti-psychotic
Medications”. These medications are typically
used to relieve anxiety, or alter behavior or mood. They
typically include: anti-psychotic agents, major tranquilizers,
antidepressant agents, anxiolytic agents and hypnotic
Psychoactive medications are not ordered, "as needed" or “PRN”,
unless the resident’s physician has determined that
the resident has the mental capacity to understand what
the medication is for and the resident can specifically
ask for that medication. In most cases psychoactive medications
are usually ordered on a routine schedule. If the resident
is going to take psychotropic medications on a routine
basis then the resident’s physician needs to appropriately
diagnosis the condition and be involved with the treatment
Facility-Physician Plan for Behavior Medication Use.
It’s common knowledge that health care policy makers
are struggling with the serious problem of medication errors.
There is a significantly greater risk for medication errors
to happen with a person who is confused or has dementia
because the person might not know if the pills they are
given are indeed their pills. Staff should always make
sure the resident gets the right medication. See Medication
Medication in the elderly can be hampered by
poor absorption and distribution within the body as liver
and kidney functioning decreases. Age, body weight and
illnesses must all be considered when the doctor prescribes
medication. Food can slow down or increase absorption.
Vitamins, minerals, and herbs can also affect a medication’s
There are appropriate and inappropriate uses of medications.
Medications are not to be used for staff convenience,
or as a chemical restraint to prevent behavior problems.
However, the right use can help a person suffering from
dementia live in the least restrictive environment as
long as possible and enhance their quality of living.
Common reasons Behavior Medications are Used:
- Will improve resident’s overall condition
- Will reduce medication-induced side effects
- Will improve or maintain resident’s mobility
improve or maintain resident’s overall functioning
- Will improve the resident’s quality of
- Will prevent falls
- Will prevent weight loss
- Will assist in diagnosis
- Will reduce sensory deprivation
- Will facilitate discharge
There is still much research to be done and there are
pro’s and con’s on both sides about the effectiveness
of psychoactive medications. Regardless of public opinion,
residents are entitled to access all effective medications
for their illnesses and symptoms. Medications can reduce
the resident’s symptoms, it will depend on the individual;
remember some medications work on some people and not on
others. From a physical aspect, medications can help keep
the brain chemistry in check.
“If the person shows improvement, and
the benefits of treatment outweigh any side
effects, treatment with the medication usually is continued
until the person stops responding to it. The person's
response to the medication needs to be assessed on a
regular basis, although this can be difficult. The medication
may remain effective longer in some people than in others.”
There are about 5 main medications prescribed for Alzheimer’s
and Dementia. Most medications work better at higher dosages.
However, the higher the dosage the more side effects. To
learn more about Dementia Medications see the Alzheimer’s
Association’s “About Alzheimer’s Medications
and Treatment.” Free download at www.alznorcal.org/abtalz/treatments and
Mental Health Sanctuary’s Psychotropic Medications
free download at www.mhsanctuary.com/rx/medications.htm
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