It is a matter of resources. Young children or adults with severe behavioural problems are managed without antipsychotics and sedatives, but it takes a dedicated and skilled care team and a highly functional family. Even then, the drugs still often get used.

Behavioural problems in dementia are very hard. Male patients in particular can be quite strong and mobile. They can easily hurt staff or other residents. They are also a risk to themselves. The coroner in my state published two cases of patients with dementia that highlight this: one swallowed the napkin on his dinner tray and choked, another got put of the facility and died trying to climb a fence.

The reality is that there are few viable alternatives.

Make a living will and think through a DNR, so that you are not kept alive against your wishes for a care facility's income stream (or even in the case of well meaning caregivers) against your quality of life interests.

I'm serious, by they way. Almost everyone on this forum (over the age of 18 in the US) should consider getting a relatively inexpensive living will drawn up with advanced medical directives.

My dad passed away with dementia in 2019, spent a lot of time in nursing homes and also making decisions about the care of my father. I actually got to see this first hand with his caregivers in his facility. The requests to put him on different drugs required me to do a lot of research, validation and getting out of pocket advice from a medical professional that wasn't associated with the care facilities.

As someone that has gone through this, there is a fine line to walk between doctors operating under their Hippocratic oath, caregivers, and patient wishes. My dad was prescribed meds that weren't helping his quality of life and had really bad side effects mentally and physically through the the mid-stages of dementia.

This is unfortunately my experience in any custodial care setting. Providers (Hospitals, SNFs, Board & Cares, Day Programs, etc...) will use whatever they can get away with prescribing that has a sedative effect, not just antipsychotic drugs.

I imagine a significant number of people diagnosed with dementia likely do not have it. The providers just want people to be docile and lie in bed. Having to monitor and manage people who may get up at odd hours and act in ways we aren't used to requires a lot of other people, which gets expensive.

The worst part is that the combination of over medication and lack of suitable care can lead to someone exhibiting symptoms similar to dementia even if they don't have it.

To be fair, funding likely isn't sufficient for many providers to do a sufficient job monitoring and working with their patients, but that's a separate conversation.

It's the same deal for troublesome kids.

For the old folks, why not morphine or heroin? That, I've heard, is at least pleasant. As long as the supply is assured, anyway. Anti-psychotics aren't so much fun.

And if that seems outrageous, please say why.

Do you know what it's like to have to explain to your mother every day that her parents are dead? That her first and second husbands are both dead? Spend a month watching her soul break anew every single day, sometimes twice a day, and then tell me drugging her until she doesn't think about it is worse than that because I fucking guarantee you there is nothing worse than that.

After witnessing family members with dementia, I've decided that unless a true cure is developed, the only 'treatment' I ever want should I get dementia is to be swiftly euthanized. I just hope that by the time that may happen, I don't have to travel far to find a way to get that done legally.

Gosh -- just the premise of the title alone -- really makes me think about what happened to my Grandma back in late 2016-2017.

I won't go into details, but suffice to say, either we got her into the nursing home at the exact right time where she absolutely needed it, or they started over-medicating her right away. Once she stepped foot through those doors, she was never the same again.

Her admittance coincided with the hospitalization and subsequent death of my Grandpa, who was her primary caregiver at the age of 92 (WWII veteran and atomic engineer, btw - smartest guy I ever knew).

Long story short, we started off getting them a two-person room where they were supposed to reunite once my Grandpa was checked out (a room which my Grandpa never made it to). Within a month, we had to move her into a one-person room. She never put two and two together (they were married for 70 years). I was the only person she recognized.

But she was never the same again once she checked in. And it was immediate.

I think think the issue is a lot more complex than they're describing. Serious dementia can be quite unpleasant, and as with physical pain, it's not clear that going light on drugs is the ethical thing to do.

Similarly, withholding meds from people in their 80s because those meds might shorten their life some seems dubious.

A nice compliment to that article, via Dylan Matthews of Vox News: https://drive.google.com/file/d/1d6vYu_uN9keb9iiT2R5UJihA_61...

Short version: paying CNA more increases lifespan and quality of life for people in retirement homes because they are more motivated and you can hire better staff.

Same in Canada. My dad has dementia and is in a home in Vancouver. They had him pretty zombified until I intervened. He's a bit of a pain in the ass, so it's easier for the staff to drug him up...

Makes sense. The staff are not so enthused workers.

They don't care for these people, they don't have any special ties with them (e.g. like family), and if they could dispose them and keep the money they would. Keeping them sleepy and docile removes them from most of their day, and makes their jobs easier.

Let me guess, the nursing home is sponsored by a Pharma company? This is how US's opioid addiction came into being. Screw the socialists, right? Profit above everything.

I get sick when I see the jokes they make on Big Bang Theory about Penny's job, she's basically a criminal (in many countries literally.)

Compared to other nations, is the US overmedicated in general?