Use of Risperdal in elderly Alzheimer's patient

[umya]

Hello, My father who is 80 years of age suffers from Alzheimer's and has been in a nursing home for 5 years.  He has been on a "low"  does of Risperdal for the same period of time.  His caregivers claim that it is for his own safety and theirs as he becomes agitated periodically.  They have not described to me in any detail how this agitation manifests itself.  I find this hard to accept as he is confined to a wheel chair and is relatively weak as his muscles have not been put to any use in several years.  He still has a firm handshake however.   My concern with the use of Risperdal comes not only from recent studies but from my experience of him since being on it.  He cannot speak, he nods off, his pupils are pin holed and he may be showing some signs of tardive dyskenisia.   I have asked that he be taken off of this drug as it represents to me a chemical lobotomy.  His caregivers agreed and simply substituted Seriquil.  Obviously I would like him taken off of this also.   I am being met with resistance and am concerned that the attending physician is completely in the dark about several studies regarding the negative effects of these particular drugs in elderly patients with dementia, or any helpful alternatives.   Are there any alternatives to using antipsychotic medications in this case?   I have a hard time believing he is being kept in this state for other than that it makes him less work for the staff.  Any advice would be greatly appreciated.  Thank you--J

[caregiver222]

Risperdal is a so-called "blacklisted" drug because of the high incidence of fatalities in the elderly. It is not approved nor appropriate for a use in an "agitated" eighty year old patient.

The Department of Geriatrics at Johns Hopkins University conducted a dedicated seminar at Mount Sinai Hospital geriatrics department three years ago warning against inappropriate use of risperdal in the elderly.

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[ILADVOCATE]

It should be noted that on the medication warning labels itself there are express concerns about the use of antipsychotics in people with dementia. You can look on the medication websites themselves. As for tardive dyskinesia that can be a concern and especially so in people that are elderly. The only FDA approved antipsychotic that won't cause tardive dyskinesia is Clozaril but that of course has a side effect profile of concern in itself as it can cause blood dyscreias. My best suggestion is to have him evaluated outside of a nursing home by a seperate psychiatrist. As well you should see if he is eligible for a home attendant under his coverage as he would recieve better care living in the community. And if he is showing any signs of tardive dyskinesia it would be essential for him to see a neurologist who is a movement disorders specialist to diagnose it and treat it. Psychosis from Alzheimer's is seperate from standard psychosis and may not respond that well to a standard antipsychotic. I know from elderly family members that had minor dementia that they responded well to Namenda but decisions as regards treating dementia would have to be made by a neurologist.