The Prescribing Cascade

"I'm having difficulty sleeping, doc." Robert's physician prescribed a sleeping aide so Robert can sleep better at the long-term care facility he resides. Then, Robert starts to feel irritable in the morning when he awakes. Subsequently, he is prescribed an anti-anxiety medication to take in the morning and as needed. Roberts starts taking the anti-anxiety medication and then starts to feel more sleepy during the day, less productive and motivated, groggy, and having difficulty concentrating. He's isolating more in his room and not spending time doing the things he used to like to do. And because he is sleeping more during the day, he isn't sleeping much at night, even though he continues to take the sleep aide that his physician prescribed. He lets his physician know that he has been sleeping more than usual, not as sociable as he used to be, is having difficulty concentrating, and unmotivated. His physician then prescribes Robert an anti-depressant...When does it stop?!

A side...

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Clean Dementia Care

In the effort to think, feel, treat, and heal clean, how does this apply to dementia care. It's pretty typical that as part of the disease process, those with dementia will display a number of behavioral symptoms as a way to communicate. These behavioral symptoms mean something. The individual may be hungry, thirsty, tired, in pain, or needs to use the bathroom. Or the individual might be anxious, sad, angry, scared, or bored. However, sometimes these behavioral symptoms put the individual and their care partners at risk for injury. It's important as care providers that we help to anticipate what the individuals in our care need so they don't have to act out to show us they need something. However, when the individual with dementia does act out we need to recognize what's happening and intervene.

Unfortunately, often times an as needed psychotropic medication is used immediately at hopes to stop the behavior. Essentially it slows down the individual and sometimes even makes them...

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