While patients with agitation are often prescribed medication, the Alzheimer’s Association believes the first steps should be non-pharmaceutical approaches: identify unmet needs, modify the environment and support caregivers.
When medication is necessary, clinicians often rely on off-label treatments such as antipsychotics, benzodiazepines and, in hospice settings, opioids. While these medications may be helpful for some patients, they also have important drawbacks.
Antipsychotics carry boxed warnings for increased mortality in older adults with dementia and can cause sedation, rigidity and falls. Benzodiazepines may worsen confusion, increase fall risk and sometimes actually increase agitation. Opioids may be appropriate when pain is contributing to distress, but they can also cause sedation and constipation.
Alternatives are needed because agitation is common and deeply distressing, yet current options do not work well enough for many patients. About 45% of people with dementia experience agitation near the end of life, and roughly one-third continue to have symptoms despite treatment.
That leaves clinicians with few evidence-based therapies to help patients remain calm, comfortable and connected with their families during the final stages of life. Anyone who has witnessed a family member in an agitated state is eager to help them. This study offers the possibility of an option that may greatly benefit patients and caregivers.
