Antipsychotic Medication: Beware Chemical Restraints

Four-point restraints and straight jackets were once commonly used for extremely agitated people who might hurt themselves or others. It’s unnerving to see grumpy grandma bound at wrists and ankles, squirming to get free. Perhaps you recall the images of a man pretzel-twisted by a leather, canvas or duck cloth straight jacket as he sits isolated in a padded white room?

Even though the days of restraints appear to be gone, they are used today more than ever! The difference:  now restraints are invisible – because they are ‘medication restraints.’ These pills have become the reflexive response to uncooperative elders, rather than serving as useful drugs for extremely agitated elders who are inconsolable.

These ‘chemical restraints’ are the method of choice for getting screaming elders to shut up and remain quiet. They quickly get wandering and restless grannies to sit down and behave. Only problem is they are overused and have many potentially serious side effects.

What’s worse, these restraints do not leave marks on the wrists, rather they leave granny in a chemical brain fog. She may remain slumped in a chair, staring at a wall or sleeping most of the day. These drugs quickly quiet granny and gramps much like a strip of duct tape across the mouth. Our newfangled invisible restraints often leave elders in a dark cloud from which they cannot emerge to enjoy quality of life during their remaining days. There remains little interest in previously enjoyed hobbies, games, music, reading or conversation. They become isolated.

That individual’s personality may be sealed off deep inside the slumped body of those who are needlessly medicated or over-medicated.

Why are we using these restraints? Because granny and gramps may be a bit feisty or grumpy or cannot sleep at night, but they must conform to our needs and schedules at the adult home or nursing home. In truth, many elders with dementia will scream to have basic needs met when they are in pain, hungry, lonely, cold, lost, scared or confused. Like babies who cry until their needs are met, those with dementia may have difficulty expressing their needs and concerns.

As healthcare professionals across the globe pump these antipsychotic meds into our elders, caregivers and loved ones should be aware of the potentially serious side effects. These antipsychotic medications can be effective and helpful in the small percentage of elders who suffer from severe behavioral disturbances. Be aware that these medications can often be reduced or tapered off at some point in the future.

Just a few of the serious side effects:

  • Black Box Warning (means it is a red flag alert):  “Elderly patients with dementia-related psychosis treated with anti-psychotic drugs are at an increased risk of death. Analyses of seventeen placebo-controlled trials … revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature.”
  • Drowsiness, constipation, headache and dizziness are common side effects
  • About 10 to 20% may experience inner restlessness or agitation from drugs that are being used to reduce agitation!
  • Blurred vision is not uncommon and can add to sensory deprivation in elders who already suffer from vision and hearing difficulties.
  • Very high blood sugars.
  • Movement problems such as stiffness, shaking and rigid muscles similar to Parkinson’s disease.
  • Drop in blood pressure upon standing up which can cause falls.
  • Check back for more valuable info on the overuse of medications in the elderly and how to solve behavioral problems in those who have dementia using non-drug approaches.