We recently received a call from a psychologist in my mom's care system, recommending psychological treatment. Anyone have experience with this treatment? - AgingCare.com

We recently received a call from a psychologist in my mom's care system, recommending psychological treatment. Anyone have experience with this treatment?

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She is a dementia/Alzheimers patient in an assisted care facility for nearly one year. Symptoms began in 2008-09. Internet research proved no success with that type of treatment in various studies for dementia/Alzheimers. We find it a suspect recommendation and are resisting the action. Does anyone have any experience with this method of treatment both successful or failed?

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There is not a simple answer to this question. Many people ask questions about their loved ones sleeping all the time and refusing to eat. Is this the result of doping - probably not. It is just the natural progression of a life winding down.

It is very easy to say that staff in say memory care should be trained to deal with hard to manage patients. Maybe they are or maybe they are not. Even if they are a 5'4" 120 lb nurse is not going to be able to control a 400lb man bent on creating havoc. So the answer is that you probably need three or more people with him all the time. So while these people are contoling this one patient who is looking after everyone else on the floor? He is not going to calm down if his hand is held and he is sweet talked all night. The only answer is either a padded cell or chemical restraints. If you are really really lucky when he wakes up from his sedated sleep he will be calm and co-operative. How likely do you think that is?

People like Barb's mother are in an entirely different category. They are medicated to make life more pleasant for them. If they have dementia it is like any other form of disease it needs medications to treat it. Medical care is there to treat disease, relieve pain and improve the quality of life. Would you deny a patient with a broken back narcotic pain relievers because he might become addicted. That is always a possibility but he is more likely to become drowsy and sleep a lot. I just had a cataract operation and I was given as are most patient's a sedative to relieve anxiety.It worked very well and made me drowsy. Was it wrong to use that drug?
Many elderly people sleep a lot. That is what they do, they are tired so if you see patients lined up in a common room asleep in front of the TV it is probably not because they are drugged. Yes it would be nice if they were alert and persueing hobbies or exercising or even chatting with their neighbors, but there comes a time at the end of life when a person withdraws into their own little world and would rather be left alone.

I personally believe that physical restraints are cruel but the only other way to prevent injury to the patient or others is to use medications. Many times I had a phone call in the middle of the night from a loved one's relative desperate for help. It would go something like this." Hi this is Mary Jones. We can't get dad to settle down and stay in bed. He keeps throwing the covers off and my husband had been lying beside him for the past two hours but he has to go to work in the morning and must get some sleep" What to do? That nice little kit hospice supplies with the Morphine and Ativan is right there in the home. Tell them I will make a visit but it will take me an hour to get there and to give Dad the smallest dose. When I arrive Dad is either sleeping peacefully or wrestling with family members. So I give more Ativan as has been prescribed. This time It may or may not work because sometimes it has the opposite effect. I sit beside the bed and Mrs Jones brings a welcome cup of coffee. I wait an hour and Dad is still too restless for the family to manage so I offer hospital admission which they gladly accept. Once in the hospital Dad can be given more medication and finally falls asleep and the family can go home and rest or frequently sleep on a chair in the room. Once in the hospital that is where dad will probably spend his final days if he needs to be sedated. It is not the ideal situation because most of us would rather die peacefully at home in our own beds.

There is far more to this question of whether it is ethical to use sedatives or not. I once had a 13 year old girl who had cancer in her leg and it had to be amputated. This was many years ago and the Drs decided that the best thing to do was to keep her heavily sedated for three days. A nurse sat with her the whole time and if she showed signs of rousing the IV could be adjusted. This worked wonderfully well and when she was allowed to wake up she was calm and accepting. Her brain had been given the rest it needed.

Most nurses do not have a lot of experience or instruction in psychiatric care unless they actually enter that field. I am among that number but being older I had enough experience to fall back on to work out the best course of action.
If you don't like what is being done to your loved one speak up.
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Tbeck my mom was "doped" as you call it. Doc's tried every combination of meds to relieve her anxiety and agitation. Nothing worked for very long. She was admitted to the hospital for a geriatric psychiatric evaluation to find a combo that would work. But, eventually many other combinations were tried, each with limited success. She was a danger to herself and others. Eventually, after a year and a half she was kicked out of the facility because she was completely unmanageable. She was on hospice at that time. The hospice social worker suggested another, much smaller facility, lower resident staff ratio, cheaper, lovely, excellent care and actually cheaper each month until you add in the 24/7 private caregiver that was necessary. And this facility's residents had ALL been kicked out by another facility. The level and quality of care mom received was the best she had.

Was mom doped as you call it? Yes, probably, but she was much more relaxed and comfortable which was much better for her. Was she asleep all the time? No, not until the couple of weeks before she passed. Sometimes meds are very necessary to be increased to provide comfort, sometimes to a level that all they do is sleep.
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Tbeck, I'm going to strenuously disagree with you.

My mother developed severe anxiety as her cognitive skills declined. She developed delusions of having a fatal disease, being in danger from floods, the IRS and the like.

Only medication worked.

Antianxiety and antidepressants gave my mother a modicum of quality if life in her last years.
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Sometimes giving medication can ease the symptoms of a patient and make them more comfortable. We don't want our loved ones to be zonked out of psychotropics, but we do want to relieve anxiety and agitation they are feeling. A good geriatric psychiatrist can find a balance that makes life better for the person. tbeck, I agree with you that it shouldn't be used for management. It would be easier on workers if everyone slept all the time. The goal should be the comfort of the individual patient.
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Just a guess... I assume psychotropic medication may be the reason a psychologist called you requesting psychiatric evals and treatment. My personal feelings on psychotropic medication, or "doping" institutionalized patients is just that, a personal opinion so take it with a grain of salt. IMO doping meets the needs of overburdened staff, it typically does not meet the needs of the patient.

I worked front-line with institutionalized patients in a professionally capacity; my patients were severely behavior disordered -- thank goodness for college degrees, promotions and admin positions because it's a very taxing career with a higher burnout rate than care-giving ;) I did not work with the elderly. However, I've recently discovered (from family members who attend our local caregiver support group) "doping" is common practice in in-patient facilities specializing in "memory care" and/or dementia. The common symptoms that typically initiate "doping" can include, but are not limited to combative behavior and/or wandering. I was horrified when the patients I supervised were doped. With new insight about the prevalence of "doping" elderly in-patients who have been diagnosed with dementia -- frankly I'm beyond horrified.

A psychiatrist is hired to prescribe the appropriate medication so the patient is easier to handle. Unless the patient is a threat to themselves or someone else, IMHO, "doping" shouldn't happen. Vegetative is the only way I can describe the final outcome. IMO, if the staff can't handle the patient this is a staffing problem not a psychological problem to be medicated away. Everyone has a different viewpoint but you should know that this is a PERSONAL decision for you to make (by law!). Again, just a guess, but I suspect a little arm twisting by admin may be in your near future if you choose not to "dope."
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My mother saw a psychiatrist a day before her death. This was first time. She was shocked when he introduced himself. She found him delightful and thought he supported her views on life in general. Her insurance paid. She did not have dementia.
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You do know Mom will pay for this. You better check to see if Medicare and her supplemental would pay for this. I agree, why a phycologist. I have even questioned a pychiatrist. My Mom had a neurologist. Does Mom use the facility doctor. If so, ask him if he recommends this and if so, why. If she has her own doctor, my question would be who evaluated her for this service without notifying you before.
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I had the same question Barb did. A geriatric psychiatrist would make sense. A psychologist wouldn't.
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Is it a psychologist or Psychiatrist? Or was the communication from a "behavioral medicine group"? 

Find out what treatment plan they are recommending.
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Do you mean talk therapy? It seems like a strange suggestion for someone with dementia, would this even be covered under her insurance?
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