Western New York’s Dementia Resource

Medication Restraint for Dementia Behaviors

Buffalo Occupational Therapy


Dementia and Alzheimer’s | Buffalo NY | Buffalo OT

Michelle Eliason, MS, OTR/L, C.D.S., CKTS


What is a medication restraint?

When a medication is used for an ‘off-label’ intention to decrease symptoms of an unrelated diagnosis, the elicited side effect could be considered a medication restraint also known as a chemical restraint.

In 2017, CMS issued a revision to the State Operations Manual which created a contreversial shift in the use of audible chair/bed alarms. Noted by surveyors to create an atmosphere of fear (emotional/phyiscal) restraint to the patient, nursing homes everywhere began to shelve this commonly used technology.

The attention now turns to chemical or medication restraints. Noted by Ina Jaffe in her article entitled “Some Dementia Patients Increasingly Given Antipychotics…” published on NPR’s website: “…data from Medicare Advantage plans from 2012 to 2015 [states] at the beginning of the study, 12.6 percent of dementia patients living at home or in assisted living had prescriptions for antipsychotic drugs. However, by the end of the AARP’s study period, 13.4 percent of dementia patients living at home or in assisted living had prescriptions for antipsychotic drugs. This is an increase of more than 6 percent.”  Thankfully, the federal government has taken notice. As of 2018 the percentage of patients with a dementia diagnosis who are receiving antipyschotic medication for behaviors has decreased, but the percentge has gone from 13.4% to current 15.8% in 3 years. This is alarming.


Thankfully, you are able to research every prospective long term care facility’s rate of antipsychotic prescriptions via the nusing home compare tool. This tool allows you to see how many of residents (Short term/long term) are issued antipsychotic medications for the first time upon entering a facility. It is important to monitor and advocate for your patient/loved one if the discussion of antipsychotic prescription arises–there may be another solution.


Occupational Therapy is an Alternative Solution


An occupational therapist offers a unique perspective when formulating the plan of care for every resident and every community dwelling older adult experiencing behaviours secondary to Alzheimer’s or other related dementias (ADRD). Antipsychotic medication to quel the behaviors associated with ADRD should and is becoming more regulated and discouraged for the frail elderly unless all other alternative measures have been taken. According the National Nursing Home Quality Improvement Campaign, Therapy is one of those alternative solutions.

How can an in house, outpatient, or consultant occupational therapist help improve quality approach to ADRD care and treatment?


CARES Dementia Specialist
A CARES Dementia  Specialist trainted occupational therapist can use a proved, evidence-based approach to create an occupational profile for personalized care.
An occupational therapist can provide education for staff, patients, and caregivers regarding best practices when working with indiviudals diagnosed with dementia.
After getting to know the patient, an occupational therapist can work with the patient, caregivers, and staff to reasonably modify the environment to aleviate secondary stressors that may be causing exacerbation of dementia-related behaviors.
An occupational therapist can help to explore and identify behavioral triggers and possible proactive solutions to behaviors associated with dementia without needing to medicate.
An occupational therapist is trained to offer a holistic point of view and provide recommendations that may help patients reach their goals and maintain quality of life without needing to compromise their ultimate desires. Looking at the entire person (mental, neurological, emotional, phyiscal, emotional, cultural, etc) and focusing on building a relationship with our patients allows an occupational therapist to be a great resource for the patient, caregivers, and interdisciplinary team throughout the course of this disease.
An occupational therapist can provide consultations to assisted living facilities, independent living facilities, caregivers requiring training/education in how to best care for their loved one with ADRD, and much more. Learning to love and partner with our loved ones diagnosed with a progressive degenerative illness is a journey, and an occupational therapist can take that journey with you and your loved one.

Michelle Eliason, MS, OTR/L, C.D.S, CKTS  is both an occupational therapist and CARES Dementia Specialist. She has been an elder care professional for 7+ years. Working in various aspects of the elder care industry has given her a generalist skill set and a broad knowledge base of elder care approaches and resources. Michelle is passionate about influencing the elder care industry advocating against nursing home negligence and elder abuse, and working with older adults to enable them to live in their own homes throughout the aging process.

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