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Effects of Behavioral Medications
For Residential 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 residents.

  • 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 Medication Consent

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 agents.

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 plans. See 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 Incident Report.

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 absorption rate.

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
  • Will improve or maintain resident’s overall functioning ability
  • Will improve the resident’s quality of life
  • Will prevent falls
  • Will prevent weight loss
  • Will assist in diagnosis
  • Will reduce sensory deprivation
  • Will facilitate discharge planning

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.

From WebMD.com

“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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