Use of Haldol for dementia / Alzheimer’s patients in nursing homes
So the FDA says the following about using Haldol for a dementia / Alzheimer’s patient in a nursing home. Read it carefully, the language is not soft but very clear:
WARNING Increased Mortality in Elderly Patients with Dementia-Related Psychosis: Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of seventeen placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10 week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. HALDOL Injection is not approved for the treatment of patients with dementia-related psychosis (see WARNINGS).
Wow. Strong words. Increase death, and injections not approved. So why then ladies and gentlemen, do I see doctors giving patients Haldol injections all the time?
What if a patient comes in and is aggressive to staff and other patients? What if the staff is scared? Is it ok to give Haldol injection then? Probably not, and not without the family’s explicit understanding of the risk. So what should the facility do? Honestly, they should tell the family we can’t safely take care of your loved one – and we are sorry.
The goal of a long term care facility is not to babysit your loved one. It is not to provide respite while the family works. It is to provide ACTUAL care – such that quality of life can be maintained or maximized.
So if you have a loved one with aggression in a nursing home, and you know they are receiving Haldol injections – question it. Point out the FDA warning and approval. Then try to find a solution where over-medicating your loved one is not the only option or answer. It’s a very tough balance and road for everyone – but the doctors need to be willing to speak with families, communicate about the risks, and seek other solutions.