I agree that, when planning therapy for psychotic and behavioral symptoms associated with dementia, it is important to understand the possible responses of elderly patients to psychopharmacotherapy. The aging process is characterized by a progressive decrease in the functionality of all vital organs, as a result of which elderly patients are more sensitive to both therapeutic and side effects of drugs taken.
Additionally, one of the most important pharmacokinetic features associated with old age is a decrease in the excretory capacity of the kidneys. This leads to the fact that drugs are removed from the body more slowly and, therefore, accumulate in it, which can also contribute to the deterioration of the body. Moreover, elderly patients with dementia usually also have multiple somatic pathologies, and, as a result, take additional medicine. Jensen-Dahm et al. (2020) state that “the focus on appropriate management of behavioral symptoms has increased, with screening for physical and environmental causes before initiation of antipsychotics” (p. 260). Therefore, a preliminary analysis of the potential interactions of one drug with another is especially important, too.
The use of antipsychotic drugs for dementia symptoms treatment in the elderly can be dangerous and fatal, but effective in the treatment of severe psychosis and aggression. According to Sultana et al. (2019), “conventional antipsychotics had a higher risk of death than atypical antipsychotics among elderly persons with CCD” (p. 187). Other, non-medical interventions might be less dangerous; however, they do not have a significant effect on more severe dementia symptoms. In my opinion, a thorough risk assessment is necessary for every specific case of dementia in elderly patients to understand how the use of antipsychotic drugs could affect their general and mental health. I agree on your point that a health needs assessment before an intervention would be the best way to treat dementia – either with medication or with other therapy means.
References
Jensen-Dahm, C., Christensen, A. N., Gasse, C., & Waldemar, G. (2020). The use of opioids and antipsychotics in elderly with dementia – have opioids replaced antipsychotics in treating behavioral symptoms in dementia?Journal of Alzheimer’s Disease, 73(1), 259–267. Web.
Sultana, J., Giorgianni, F., Rea, F., Lucenteforte, E., Lombardi, N., Mugelli, A., Vannacci, A., Liperoti, R., Kirchmayer, U., Vitale, C., Chinellato, A., Roberto, G., Corrao, G., & Trifirò, G. (2019). All-cause mortality and antipsychotic use among elderly persons with high Baseline cardiovascular and cerebrovascular risk: A multi-center retrospective cohort study in Italy. Expert Opinion on Drug Metabolism & Toxicology, 15(2), 179–188. Web.