Quick answer: Sedating drugs can calm agitation. They also raise the risk of falls and confusion. Some raise the risk of death in older adults with dementia. Before you agree, ask what causes the behavior and what was tried first. Also ask how long the medicine will be used.
This is general information, not medical advice. Talk with your parent's doctor about their own situation.
Maybe you just heard your parent was "started on something to help them settle." Many families learn about a new medicine after the fact. This guide covers the questions to ask, the warning signs and your parent's rights.
What counts as a sedating drug
"Sedating drugs" is a family of medicines that calm a person or make them sleepy. In memory care, the ones families hear about most are antipsychotics, anti-anxiety medicines and sleeping pills.
These medicines are sometimes used when a person with dementia is very agitated, scared or aggressive. They can help in some cases. They can also cause dizziness, more confusion and falls.
Ask the care team for the name of the medicine, the dose and why it was chosen. Write it down, along with the date it started.
The FDA warning families should know
Antipsychotic medicines carry an FDA "boxed warning," the agency's strongest label warning. It says older adults with dementia-related psychosis who take these drugs have a higher risk of death. In the studies behind the warning, the risk was about 1.6 to 1.7 times higher than with a placebo. You can read it in the FDA prescribing information for one of these medicines.
This does not mean the medicine is never right. It means the reason for using it should be clear, the dose low and the plan reviewed often.
Non-drug steps to ask about first
Agitation often has a cause the person cannot explain. Ask the staff whether they checked these first:
Pain, constipation, hunger, thirst or a full bladder
An infection, such as a urinary tract infection
Hearing aids and glasses that are clean, working and actually being worn
Too much noise, glare or activity, especially late in the day
A change in routine, room or staff
Boredom: music, a walk or a simple task can help
Ask what the staff will do differently if the behavior happens again. A written plan is more useful than "we'll keep an eye on it."
Questions to ask before you agree
You can use these at the next care meeting or on the phone:
What behavior are you trying to treat, and when does it happen?
Which non-drug steps did you try, and for how long?
What is the medicine, the dose and the main side effects?
Who prescribed it, and did they see my parent in person?
How will you tell whether it is working?
When will you try lowering the dose or stopping it?
Will you call me before any change to this medicine?
If your parent can take part in the decision, include them. Explain the choice in short, simple words.
Your parent's rights
In a nursing home, federal rules ban drugs used as a "chemical restraint." Staff cannot use them to punish a resident or for their own convenience. Residents also have the right to be fully informed about their medicines and medical condition. These rights are listed in the CMS guide to nursing home residents' rights.
Many memory care units are part of assisted living, not nursing homes. Assisted living is licensed by each state, so the rules vary by state. Ask the community for its written policy on medicines used for behavior.
Every state has a free, confidential Long-Term Care Ombudsman program. Ombudsmen help residents of nursing homes and assisted living with complaints about care and rights. Learn how they work from the National Ombudsman Resource Center.
If the community says your parent must leave
Sometimes families hear "if we can't use the medicine, your parent can't stay." Take a breath before you answer.
Ask for the reason in writing.
In a nursing home, ask for the written discharge notice. Except in emergencies, it must come 30 days ahead, and you can appeal to the state.
A nursing home cannot make your parent leave while a Medicaid application is pending.
In assisted living, ask for the state rules that apply. They vary by state.
Call the Long-Term Care Ombudsman early. They can join the conversation with the community.
When to call 911 or the doctor
Call 911 if your parent cannot be woken or has trouble breathing. Also call 911 for a fall with a head injury or sudden weakness on one side. Call the doctor the same day for new confusion, a fall, dizziness or heavy sleepiness after a medicine change.
Common questions
Can a memory care community give my parent a sedating drug without asking me?
Rules depend on the setting and your state. In nursing homes, federal rules require that residents be informed about their care. Ask the community for its policy in writing.
Is it always wrong to use an antipsychotic?
No. Sometimes it is the right choice for a short time. The FDA warning means the reason, dose and review plan should be clear.
What can I do if I think my parent is overmedicated?
Ask for a care meeting and a medicine review with the prescriber. You can also contact the Long-Term Care Ombudsman.
Who pays for an ombudsman?
No one. The program is free and confidential.
Bottom line
Ask why a sedating drug was started, what was tried first and when it will be reviewed. Keep a written record. If you are worried about your parent's rights, call the Long-Term Care Ombudsman.
If you are comparing memory care communities, you can search memory care near you on Ubora Health.
Related reading: When Memory Care Might Be the Kinder Next Step, Memory Care vs. Assisted Living and Medication Safety at Home for Older Adults.
Sources
- Prescribing information with boxed warning: increased mortality in elderly patients with dementia-related psychosis — U.S. Food and Drug Administration
- Your Rights and Protections as a Nursing Home Resident — Centers for Medicare & Medicaid Services
- About the Long-Term Care Ombudsman Program — National Ombudsman Resource Center
- Medicare Coverage of Skilled Nursing Facility Care — Medicare.gov
