Chemical restraint

[Vcal2017]

Hi: my Dads nursing home just rang and said they would like to start using anti-psychotic medications, aka chemical restraints, due to verbal and physical aggression directed towards staff. He has Alzheimers and has been in a home for 2 years. I feel very mixed about this, I’m in agreement but am I BU to think a) maybe it’s part of his condition and b) this is the beginning of the end of his life?
Also, I love my Dad and don’t know what is the right thing to do .

Find out what the drugs are and if they're licenced for Dementia. My grandmother was given these and as can happen with any anti psychotic they made her much worse and she broke her hip.

I am sorry you are going through this.

Have a read of this about managing the Behavioural and Psychological Symptoms of dementia. The antipsychotic risperidone can be used in severe cases, and sadly is sometimes needed.

www.alzheimers.org.uk/sites/default/files/2018-08/Optimising%20treatment%20and%20care%20-%20best%20practice%20guide.pdf?downloadID=609

If he is being physically aggressive to the staff then there aren’t many other options even if it is part of the condition. No one should be attacked at work. Ask for more information about what they are , the side effects and any alternatives.

at this point alternatives will be slim as your dad is probably too far down the line to move car homes but the staff can still refuse to help when he is having an episode leaving him at risk.

I know how this feels but it may be the only option. My mother had medical restraint for getting scans done as she didn’t understand what was happening. I understand where you are as we are headed to the same destination.

His behaviour IS part of is condition. Just think about what your DF would say if he were capable of understanding. Would he be happy knowing he was hurting staff daily?
My stepfather had dementia and became very aggressive so was prescribed anti psychotics. They helped him enormously. He didn't turn into a drooling old man slumped in his chair if thats what you think could happen. Your DFs GP wouldnt prescribe them if he didn't believe he needed them.
Oh and my SF lived for another 2 years after being prescribed them.

Ask what medication they plan to use and read up on side effects. Lorazepam and risperidone are often used where I work and the dosage given is normally very small and staff are well aware to montitor for any adverse effects...if staff are being attacked I'm afraid that there is not a lot of other options as next time it may be another resident they are aggressive with and that is taken much more seriously. This doesn't mean that he is nearing the end, we have had many residents that once settled on medication that they are also much happier and have a better quality of life. If you refuse the care home can also decided that they can no longer meet his needs due to the aggression and ask that younfind another placement for him. It is hard but they would not be taking this decision lightly.

Thank you all for the information. I very much agree that no-one should be attacked at work, and I’m sorry if my post implied that. I guess I’m just trying to navigate the stages of this awful disease. Everytime I think things are settled, a new thing crops up. And he would hate the idea that he’s being aggressive to people .

His behaviour (and the causes of it) are a part of his condition, and are likely causing him as much distress as they are causing the staff who have to manage it.

With any medication you have to weigh up risks vs benefits. Just because the symptoms it will treat are behavioural rather than physical, it doesn't make any difference. It could lead to a much calmer and happier life for your dad and that is the entire point of it.

With some dementia's such as Lewy Body, distressing hallucinations are very common (and scary for all). These hallucinations can cause aggression because no-one believes the person with dementia can 'see' all the people in the room, or whatever that hallucination is. They can also believe that the people they 'see' are there to harm them.
Antipsychotics can help enormously; please allow them to use these and see how they go. If you feel they are not helping after a trial, ask the medics to try a different drug. But please don't dismiss them as 'something to keep your relative quiet' or to 'send them off', just because you've heard, or people here will relate horror stories.
They are NOT chemical restraints - they serve a purpose.
I speak from experience caring for a parent.

"Chemical restraint" is the current terminology given to drugs that work on the brain. It doesn't (shouldn't!) mean that he's actually being restrained, if that's what you're worried about? If he gets to a point where he is sedated, sleeping all day, losing mobility, appetite, or quality of life, then the dose is too high or the med doesn't suit him and the doctor needs to review it.

Some residents I've looked after on these meds have still been able to verbalise their feelings, and have told me how much better they feel after taking them because they don't feel so anxious/restless/irritable and can have a much nicer day.

I guess it’s the word restraint that seems awful. There was a royal commission here in Aus a few years ago into aged care and as a result, aged care providers have to be very careful about using these drugs, so yes, I think it’s probably come to that, I just wasn’t sure if it’s an end of life situation, but thanks to posters I now know it may not be. ♥️

I think the term chemical restraint is misleading and inappropriate.

Your dad is likely experiencing distress and fear leading him to lash out, certain medications can be used to reduce those symptoms of distress thus reducing the risk to others.

No one wants their loved ones ‘drugged up’ but these situations are generally carefully managed with low doses of medication used, close monitoring and consideration given to falls risk.

You are thinking of it through the wrong lens. Rather than a ‘chemical restraint’ it’s a medicine that will make him feel more settled and happier in himself. It’s very common that elderly need such help to make them feel more comfortable. Once he settles into it, he should be much happier.

However, be warned the majority of these meds have a ‘settling in’ period. It’s not unusual that someone will sleep nearly all day for the first fortnight once starting these meds, but don’t take that as the new normal, it’s an adjustment period for the body, then they settle into it, so I wouldn’t judge by the first six weeks but what he is like after that.

If he distressed to the point of being abusive to staff, why would you not want him to feel calmer and more settled?

You also need to consider that if the nursing home feel they can no longer meet his needs due to his behaviour they may move him to a different facility. I have first hand experience of this and it was really distressing for everyone involved.

Just to be clear, the nursing home referred to the possible medication as ‘chemical restraint’ I much prefer to think of it as medication for symptoms of his condition.

My dad was on these. It really helped him regain a quality of life as he was no longer distressed and scared of everything. It was like he'd had a couple of glasses of wine, he was just much more relaxed.