Combating the Over-Prescribing of Anti-Psychotics


A troubling study published on Monday by Human Rights Watch has been trending on national news this week. The study “They want docile” finds that nursing homes providing care for residents with dementia are over-prescribing antipsychotic drugs to reduce challenging behaviors. Regardless of the healthcare environment, caregivers of those with dementia must be trained to understand all behavior is a form of communication. Once they are trained to do this they can effectively de-escalate challenging behaviors without medication.

Here’s what A.J. Cipperly, our National Director of Memory Care and Training, has to say about the study:

Medications are commonly prescribed as a solution to what is labeled as “challenging behaviors”. However, these challenging behaviors are most often the result of changes to the brain associated with dementia. For example, how many of us would let a stranger come into our bathroom with us and start undressing us? I imagine we would all exhibit some “resistive behaviors” in that case, similar to situations that sometimes happen for residents living with dementia.

Because of what is happening in their brain, a resident with dementia may not recognize the caregiver, so the caregiver becomes a stranger. Residents diagnosed and living with dementia may scream or become extremely agitated or combative during care, just like any of us would in the same situation.

The solution in this example is not to choose medication as the quick-fix. Understanding that the challenging behavior is a result of what is happening in the brain of resident experiencing dementia is the key. Adjusting the approach of the caregiver will ensure resident does not feel threatened and increase their ability to connect.

Dementia caregiver training is essential and one of the main ways we at Inspired Living are able to prevent many of these so-called “challenging behaviors”. Our dementia training and support groups are available to the public at each of our communities. We are proud to be a training resource for all caregivers and an advocate for all seniors with dementia.

Part of our training is helping caregivers change the way they see “behaviors”. Rather than seeing them in a negative light, as something that needs to be “managed”, we see these behaviors as a way the resident is trying to communicate. Instead of trying to be challenging, they are attempting to communicate a need. This could be a physical need, like pain or hunger, or it may be an emotional need like fear or boredom. Once we are able to see behaviors as a way of communicating, we can support the dementia resident and their needs, therefore preventing many of these challenging behaviors.

Once we are able to see behaviors as a way of communicating, we can support the dementia resident and their needs, therefore preventing many of these challenging behaviors.

The next step in this training is learning specific skills to use to help avoid potential “triggers”.

Here are some helpful de-escalation techniques:

  1. Respond, Don’t React:It is important to learn how to respond rather than “reacting” to behaviors when they occur. Being able to de-escalate a situation is critical in these cases. Instead of trying to get a resident to “calm down”, which often makes them more upset, we “mirror” their facial expressions and body language to validate their emotions. For example, if a resident looks upset and concerned, we need to be upset and concerned with them. Only then can we connect with them, bring the emotions under control, and then try to understand what is causing the emotions. It doesn’t matter if the reason for the anger is “real”, (“Someone stole my wallet!”). What matters is that the resident is angry, and we need to be angry about it as well. (“Someone stole your wallet? Are you kidding? I hate that happened to you! I’m going to look into that for you and make it right.”)
  2. Turn a Negative into a Positive: Another technique we use is turning negatives into positives. No one likes being told “no” or that they can’t do something. Rather than using those negative or “parent” words, we choose to use a positive phrase. For example, instead of saying “You can’t go there.” If a resident is attempting to exit the community, we might say, in a very friendly way, “Well, hi there! I’m so happy I found you! I’ve been looking everywhere for you! I sure could use your help with something, if you don’t mind.”


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