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Ask
the Pharmacist By Ron and Marla Chapleau |
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Q: My dad is suffering from some form of dementia and at times he can get very agitated. What can we do? A: With our aging population living longer and many choosing to live at home for as long as possible, this situation poses a challenge for both family members and health professionals. Like all health care challenges, there is no single solution that works best for all patients. Most experts would agree that all pharmaceuticals, some more so than others, pose risks of significant side effects in this group of people. As such, the best way to initially tackle this is through the use of non-drug methods, such as moving the affected person to a calm environment or altering the person's surroundings so that you minimize noise (although music and “white noise” can be helpful) or sudden changes around them. Knowing/developing soothing rituals can also be very beneficial. When the patient has settled, try to determine a possible cause for the aggression. Frequent suspects are pain, constipation, dehydration, infections or side effects from new medicines. Unfortunately these actions require your presence and your time, commodities that are often in short supply. If the aggression is occurring frequently, drugs can be considered although some experts suggest reserving them for only those patients whose own safety or that of those around them is jeopardized. Doses used should be initially very low - one-quarter to one-half of a regular adult dose - and increased slowly if necessary. It is best to try these medicines on a short-term use as well since behaviour problems tend to come and go. Anti-depressants, such as citalopram or venlafaxine, might be the best option due to their relative lack of side effects, but their benefits may take weeks to occur. Mood stabilizers, such as lamotrigine and valproate, are controversial due to conflicting evidence as to how well they work and possible adverse effects.
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Anti-psychotics (quetiapine, olanzapine, risperidone) are even more
troublesome because even though they are effective, they have been found
to increase stroke risk and mortality in the elderly demented
population. They should probably be reserved for those with
disabling delusions or very aggressive behaviours. Benzodiazepines (lorazepam, oxazepam and other “pams”) should usually be avoided as they can actually increase agitation by worsening the cognition of the individual. For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination Scrolling stops when you move your mouse inside the scroll area. You can click on the ads for more
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