Getting old and marching towards our inevitable passing away have never been easy for humans across the ages, except in some cultures where there is a fatalistic conception of life or a more mature assumption of natural events.In our modern societies the drama is compounded by the radical breakdown of family ties that confine the elderly people to hospitals and nursing homes.
The medical and nursing personnel of assisted living facilities seem all too ready to use antipsychotic drugs to treat the delirium of elderly patients, instead of using preventive measures like the company of someone that provides some attention and comfort to them. Nurses must limit the evening-hour disruptions in sleep, noise and lights while doctors should refrain from prescribing drugs with anticholinergic effects, treat pain and hydrate them.
MR Agar et al. studied the efficacy of risperidone and haloperidol in the treatment of delirium of elderly patients by enrolling 247 patients at 11 inpatient hospice or hospital palliative care in Australia from August 2008 to April 2014. Eighty two patients received risperidone, eighty one received haloperidol and eighty four received a placebo; age-adjusted oral doses were administered every 12 hours for 3 days based on their symptomatology.
After 72 hours the patients receiving antipsychotic drugs had significantly higher symptoms of delirium than those taking the placebo; they also had extrapyramidal effects like acute dyskinesias, dystonic reactions, tardive dyskinesia and Parkinsonism. Patients receiving haloperidol had much more sedation on the “Richmond Agitation Sedation scale” than the placebo. Patients in the haloperidol group had much better survival than the placebo.
Experts in Geriatrics have long criticized the quick fix of administering an antipsychotic drug to the usually frail elderly patients and have advocated the proper training and assignment of critical resources to physicians in the provision of environmental and biopsychosocial interventions to treat them. Dying is a messy, oftentimes chaotic, process tainted with numerous cultural overtones, which must be understood by caregivers for the elderly patients.
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Don’t leave me alone.