Question

1. What do you think is the most challenging aspect of prescribing medication for a patient with dementia? Why do you think this aspect is so challenging?
2. Choose a medication you would prescribe to treat dementia. Note the dose and administration for this medication. Why you would choose this medication and what outcome do you expect from using this medication? What side effects should you be mindful of observing?

Answer 1

Ans) Carers problems in assisting these care-recipients with medicines could also be compounded by a lack of understanding and challenging behaviours of the person they were assisting.

- Sometimes differing views of carers and care-recipients regarding the need for medicines could present dilemmas for carers, who despite witnessing symptoms of disease progression, generally wished to encourage patient autonomy in decisions regarding the use of medicines.

- Carers were generally strong advocates of patient autonomy and worked in their best interests. Accordingly, care-recipients interviewed in this study, though limited in the perspectives they could provide, acknowledged their dependence on their carers.

- Carers experiences of communication and support from health professionals was hugely variable. While some carers identified key health professionals and clinic staff who were understanding and helpful, some carers identified areas to be addressed.

- Carers were keen for care-recipients to be informed, involved in decisions and to retain control over their medicines as much as possible. However, consultations that focus on a care-recipient's needs should also address those of carers.

- Some carers also expressed dissatisfaction with the balance and focus of consultations involving a health professional, patient and carer. This might be insufficient attention to the perspectives of either the care-recipient or the carer. As disease progresses many carers, while wanting the care-recipient to remain central, were frustrated at the difficulties of ensuring their need for information and concerns were addressed.

- To ensure that carers are able to perform their roles effectively, there is a balance to be achieved between preserving care-recipient's autonomy and independence while ensuring a process in which carers are involved, informed and supported in their roles.

- Carers also experienced difficulties in being able to contact health professionals themselves for information. While some consultations were helpful, outside these, formal channels of communication for carers were not described. Issues of confidentiality and patient autonomy may present barriers. A particular problem for carers was that they would not necessarily be informed of changes to prescriptions or regimens. This difficulty has been identified in other studies and reflects poor systems for communication between primary and secondary care in the UK as well as with family carers.

- While other studies have identified medication-related roles of family carers, 6–8 assisting a person with dementia presents additional issues that need to be taken into account in designing services. However, many older people will have many differing needs and some who do not have a diagnosis of dementia may experience memory problems that will have implications for carers.

- The two most commonly prescribed medicines for dementia are cholinesterase inhibitors and memantine (Namenda). Doctors use them mainly to treat the symptoms of Alzheimer's disease, which is the most common kind of dementia. They prescribe them for other kinds of dementia as well.

- These medicines include:

Donepezil (Aricept)
Galantamine (Razadyne, Razadyne ER, Reminyl)
Rivastigmine (Exelon)
What to expect: Most people with Alzheimer’s who take one of these medications get some benefit from it, including less anxiety, improved motivation, and better concentration and memory. And some are able to continue with their regular activities.

But the improvements don’t seem to last long -- about 6 to 12 months. They mainly delay the worsening of the disease for a period of time.

All three medicines work similarly, but one might work better for your loved one than it does for someone else.