Agitation in the Demented Elderly

Medication management—the missing link in dementia interventions

“…The US 1987 Omnibus Budget Reconciliation Act restricted the use of antipsychotics to certain approved indications, but only achieved a reduction in antipsychotic use of between 28% and 36% (Furniss, 2002;National Long Term Care Ombudsman Resource Center, 2011). Pharmacological methods will still be needed to treat acutely challenging behaviour; such a rigid and ambitious target may have adverse consequences such as the use of alternative unlicensed therapies, for example, benzodiazepines, which are themselves associated with serious side effects (Ancill et al, 1991;Guthrie et al, 2010). Indeed, one large study involving 4850 nursing home residents, which examined the impact of the Omnibus Budget Reconciliation Act guidelines, noted a 48.6% increase in regular and a 27.5% increase in 'as required' prescriptions for anxiolytics such as benzodiazepines and buspirone (Borson and Doane, 1997).…”