According to Human Rights Watch in an average week, nursing facilities in the United States administer antipsychotic drugs to over 179,000 people who do not have diagnoses for which the drugs are approved. Often, these drugs are dispensed like candy, without free and informed consent. . . without a family member or someone who holds durable power of attorney for the health care resident, to make a decision based on the benefits and risks of taking the medication.

Like my late husband, most of the patients who are given these drugs have some form of dementia or Alzheimer’s.  My husband was in a memory care home for two years. Towards the end of his illness, he was given an antipsychotic drug because his behavior became “difficult.” He was not combative, and he was mostly non-ambulatory. Once, though, while sitting, he swung out his arm and hit a woman who was bothering him. Since I wasn’t there, I don’t know the details. But in general, he was a sweet man up until the end. He did get annoyed, however, by other residents’ behavior. And so he was given a drug to pacify him. After visiting him over a period of a few weeks and noticing the deterioration in his overall wellbeing, including his inability to hold his head up, sit upright, or staying awake most of the day, I demanded that he be taken off a number of drugs. The improvement was dramatic and astounding.

According to the US Government Accountability Office (GAO) analysis, facilities often use antipsychotic drugs to control common symptoms of Alzheimer’s. These drugs are associated with clinically significant adverse effects, including death. Then why are they being prescribed to an extremely vulnerable, frail and “at risk” population? Because disruptive behaviors such as crying out “help me, help me” over a long period of time, or yelling out profanities, or exhibiting aggressive behavior can become a nuisance that caregivers –professional and family–are either not skilled in addressing or are too busy taking care of other patients to be bothered with.

What are the alternatives?

First:

• Eliminate noise and disruption.
• Make sure the patient does not have a urinary tract infection.
• Evaluate physical needs. Is s/he thirsty, hungry, constipated, etc?
• Encourage the patient to verbalize feelings and needs, if possible.
• Limit or reduce caffeine.
• Reduce external stimuli (loud TV or radio, etc.).
• Dim the lighting.
• Avoid confrontation and use a soft, sweet speaking voice.
• Provide companionship.
• Identify events or issues that trigger behaviors.

Once you know the patient is safe and free from pain due to an infection, create a calm and beautiful environment.

Creating a beautiful space

• Maintain a clean environment without clutter.
• Enjoy a vase of fresh flowers.
• Burn incense to clear and purify the air, unless the smoke or odor is irritating.
• Paint the walls a color that rejuvenates the spirit. For instance, green is healing and relaxing, red restores vitality in people who are depressed, and purple is powerful for those who need spiritual and emotional healing.
• Gather gemstones. They exert healing effects. Lithium quartz is said to ease tension and stress, and keep nightmares at bay. Pink Calcite promotes compassion, healing, and universal love. Amethyst is for protection, purification, and spiritual/divine connection.
• Listening to calming sounds can relax a tense body within minutes. Consider a wind chime, water fountain, or a CD of singing birds, ocean waves, or falling rain.]
• Use essential oils or aromatherapy to have a specific effect on the body, mind, and spirit. (See Aromatherapy, Chapter 18 in “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia.”)
• Create an outdoor sacred space with river rocks, a koi or lily pond, a flowering tree or shrub, pampas grass, colored sand—the possibilities are endless.
• Include religious symbols, chakra symbols, animal totems, prayer flags, angel statues, rainbow banners, and lamps with colored bulbs.

Herbal remedies

• A nervine is a plant remedy that has a beneficial effect upon the nervous system.  Nervines are especially useful during times of stress because they have a strong relaxing and calming effect without producing a dulling, “hang-over” side effect.  They also tone and restore the nervous system to a more balanced state.  Some nervines are also anti-spasmodic, meaning they relax the peripheral nerves and the muscle tissue, which in turn has a relaxing effect on the whole system.
• The main types of nervines are tonics, relaxants, and stimulants.
• Nervine Tonics – are particularly helpful for strengthening the nervous system and restoring balance. In addition to having a relaxing effect, they have a vaso-dilating action on the blood vessels of the brain.  This increases oxygen availability to brain cells and helps with mental agility and mood.
• Nervine Relaxants – are especially beneficial for short-term use, for example in treating mild depression or acute anxiety. “This group of nervines are most important in times of stress and confusion, alleviating many of the accompanying symptoms. They should always be used in a broad holistic way, not simply to tranquillize.  Too much tranquilizing, even that achieved through herbal medication, can in time deplete and weigh heavily on the whole nervous system,” says renown herbalist David Hoffman.
• Nervine Stimulants– are used as a restorative “pick-me-up” when you need an energetic boost without that revved up feeling produced by caffeine.
• Recommended nervines:
• Passion flower- helps soothe anxiety, insomnia, tension headaches, muscle aches and spasms, pain, hyperactivity, epilepsy, and helps alleviate anger and lower blood pressure.
• Skullcap – is antispasmodic and relaxing and is recommended to relieve headaches, mood swings, insomnia, premenstrual syndrome, and nervous tension and exhaustion.
• The next time your loved one is  feeling nervous, agitated, restless or hyped up, try calming him/her with a nervine herb or aromatherapy. If your loved one is on medication, please check with the physician to make sure the drugs do not interact with the nervine herbs.

Other ways to help a person with dementia relax and feel calm without the use of antipsychotic drugs.

• Aromatherapy
• Music
• Pet therapy
• Horticulture therapy
• Color therapy

For detailed information on all of the above, read  “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s and Dementia”