Diazepam for Aggression

CateM

Hi everyone

Relatively new here and was wondering if anyone had experience with a LO taking diazepam for aggression in dementia patients. My gram has vascular dementia and we are looking for some more effective ways to treat her sundowners. She has suffered from it for years. We have managed up to this point with schedule and process changes in her routine and that has seemed to work. But now she has morning problems as well and is becoming more combative in the morning, even though her daily routine in the morning is the same.  She does get showers in the morning which she now hates so we have tried moving it to late morning or on worse mornings, given her a sponge bath. We have really resisted up to this point the medication route but feel we may need this as an option.  And note there have been no changes to her routines morning or evening or caregivers.

Her doctor has recommended Diazepam. We've been doing some reading about it but I am unclear on some of the problems we may encounter. I have read about the fact it may make her for example more confused which leads me to believe it may complicate part of the problem.

Anyone with any experience or advice would be appreciated.

Cate

star26

This is a common drug that’s been around a long time. In the 70’s-80’s it was given out like candy, at least in my circles. Even the dentist was prescribing huge amounts of it. It’s addictive and people like it because it makes you feel relaxed. I wouldn’t worry about it contributing to your grandmother’s memory or confusion issues but I would monitor her to make sure that it doesn’t increase her risk of falls if she is too relaxed or sedated. The MD likely prescribed a modest dose, but you could break it in half the first time you give it to her if you’re nervous. That’s what I did with my Dad. Then I ended up giving him the other half and it still didn’t make any difference. This might not even work with your grandmother, but if it does I would feel comfortable using it. Some people need to use medications that carry much more risk and side effects than diazepam. Reducing your grandmother’s agitation will improve her quality of life so I would definitely stay committed to treating this symptom.  P.S. Shower her a maximum of once per week.

towhee

CateM, I agree with the previous poster. Unless someone is really incontinent there is no reason to give a shower every day. One or two showers a week is fine and there is nothing wrong with a good sponge bath replacing one of the showers. Shower hesitancy is a topic that comes up fairly often on the boards, you might want to search the archives (though they are a hassle).

Regarding the medication, is the doctor recommending Valium her PCP, a neurologist, geriatic psychiatrist, or geriatrician? I personally would not trust a PCP to prescribe this type of medication for an older person with dementia. With medications you have to balance benefits against side effects and that balance is different with each person. Side effects vary with each individual for various reasons, including other medications they are on. If you have been reading about diazapam (Valium) you know it is in a class of medications called benzodiazepines of which there are several. Valium happens to last longer in the body than some of the others. Ativan ( which is the one mentioned most often on the message boards as being prescribed) is more short lived. They all have a sedating effect so you have to be careful with balance issues at first. They can dry you out and cause constipation issues. Rarely, they can cause vision problems. Neurologists seem to tend to prescribe Ativan. Psychiatrists tend to prescribe seroquel, a totally different type of medication, with its own set of issues. I recommend watching the youtube video "UCLA Health Medications for dementia, what caregivers should know" 

With my LO, she took the lowest dose of Valium once, a year before any signs of dementia. Added to the other three medications she was taking, all of which had sedating effects, she slept so hard I could not wake her up for hours and when she did wake up for about 5 minutes she did not know who she was. Ativan at the lowest dose once a day occasionally several years later made her sleepy, but caused no other problems.

Some people posting here have linked morning behavior problems to blood sugar, mild dehydration, low salt, etc. Any new behavior problem can indicate a new or worsening medical problem, and it is always wise to have your LO checked out, but sometimes medication does end up being necessary. I really admire that you are trying all non medication options first.

CateM

Thanks for the advice and input. It's valuable. I passed it onto my mom. She and I are 2 of grams caregivers and mom has her POA. Mom also talked to the pharmacist about the Diazepam and her current drug combination and I think we have a much better understanding.

Gram is 95 going on 96 by the way and you would not know. She's lucky in a lot of ways. The gram I remember when I was a child growing up is really not here anymore but she is still has many good moments when she can be calm, loving, and willingly accept affection. Then there are times like last week on an evening when I was with her and later in the evening she didn;t know me - it was her sundowners time of day. And I felt so guilty afterwards because one of the few things she still enjoys is getting out walking and I took her downstairs in her complex and we walked and sat when I knew she was overtired and when we got back to the apt, she was loaded for bear. Mom tells me not to feel guilty but it's hard when you know you might have been able to prevent it. But while gram doesn't talk anymore, she does when she is angry and her speech is clear. But never speaks any other time.

Anyway, her main doctor is her PCP of 25 years but the local practice does have a Geriatrician who her main doc referred us to see. He generally tends to handle and is who we contact with issues related to her dementia or issues we think are.

I'll pass on the advice to mom about the showers. One of our other caregivers had already mentioned this to my mom - reducing her showers - which we are kind of already doing. I think we were mainly concerned initially about disrupting her normal routine but we understand at this point that its no longer one of her favorite activities.

Marta

I never prescribe diazepam for the elderly. If I did, I would immediately hear from their insurance company that diazepam is contraindicated in the elderly due to its long half-life, which causes it to accumulate (especially when kidneys are over 90 years old). Accumulation inevitably leads to sedation and falls and even respiratory arrest.