Potential anti anxiety meds and fall risk?

Sandy5691: Perhaps you should seek the response to your query from your LO's physician.

People with dementia go through phases. Hopefully he'll be happier in his next phase. Keep your attitude as upbeat as possible and let him know he doesn't have to worry. Best wishes to you both!

Just sharing my experience: My 91-year-old mom has lived her whole life with anxiety, depression and OCD. She takes sertraline (Zoloft, 100 mg/day) and diazepam (Valium, 2.5 mg 3x/day). There is an increased fall risk with the meds BUT there is also an increased fall risk with the anxiety -- it diminishes her overall capacity for anything and everything (walking, cognition, etc.). So for her, the meds have definitely been a net benefit. Everyone is different so you might need to experiment to find something that works for your LO. For what it's worth, I have panic disorder myself, and personally I'd rather suffer almost any physical consequence than be without my own anti-anxiety meds. During the worst of it I would gladly have chopped off a limb in exchange for a quiet mind.

Papa’s doctor put him on Trazadone. His anxiety was terribly high, he could not sit still just fidgeted constantly. The Trazadone helped tremendously, it also let him get a good night’s sleep finally. There seemed to be no side effects.

AARP Article: Sundowners Syndrome

https://www.aarp.org/caregiving/health/info-2017/ways-to-manage-sundown-syndrome.html?cmp=KNC-DSO-CAREGIVING-HealthRelatedConcerns-22817-GOOG-SundownSyndromeCare-Exact-NonBrand&gclid=Cj0KCQjw37iTBhCWARIsACBt1IwtAJ6hR0CV9NGZuFsgMXpNlxWw9e0jZHLxSBvnWnOsX4gePd0xoZcaAkStEALw_wcB&gclsrc=aw.ds

My dad who is very good nature and in the moderate to severe stage of dementia was becoming more anxious with sundowners so his doctor put him on citalopram 10mg. The drug has been around for over 20 yrs but has less major side efftects than some of the newer meds and the dosage given is at the lowest recommend amount. Dad is not sleepy with the med just not as anxious when sundowners hit plus I had to change how I approach him in his sundowner mode.

CBD oil a dropper full after lunch when needed - happy hemp Buddha 2400 x strength - it is calming .

All medications that cause sedation will increase the fall risk. Drugs that can relief anxiety and cause no sedation are the so called beta blockers (propranolol, atenolol, metoprolol). However they may drop the blood pressure.

I consider this conundrum a little differently.

My LO was falling frequently at home, with progressively escalating degrees of injury.

She was also perpetually anxious and depressed.

After a relatively stormy arrival in AL, followed by an almost immediate transfer to MC, we had a formal assessment done and learned that she was already living with moderate dementia AND her anxiety level was increasing.

I requested a ”trial” of a small dose of anxiety medication, and it was successful.

She continued to have a fall once in a while, but was now in a setting where her welfare could be monitored round the clock.

Similar to your LO, once the correct level of medication was reached, my LO began dressing as she had before entering full time care, cracking jokes, and interacting appropriately with other residents and staff.

If there is an on staff geriatric psychiatrist, as in our situation, you’re half way to where you need to be.

My LO is also anxious and has dementia. The doctor at my request gave him quetiapine/seraquol. I administer it once at about 2-3 pm depending on his agitation and again two before bedtime. It has helped but it doesn’t change him completely. Anxiety, seems to be rational in dementia because the patient can’t comprehend all that is happening with their mind and hence their life. It causes some sleepiness but also calms. It depends on the person.

I'm grateful that my psych doc allows me to still take A benzo for my GAD. I am not really ever going to be 'better' and will probably be on some small dose for life.

I've never had dizzy episodes or fallen while on it. But I'm also only 65.

There are many things that elders can take for anxiety, it's a matter of patience finding the right med and the right dose. If I give my 260 lb hubby 1 mg of klonipin he sleeps for 2 days. I take the same amount and just calm down.

So we know he is super-sensitive to benzos and if he has a panic attack, he gets like 1/4 of a miligram.

My 92 yo MIL takes Valium, everyday and it does help her to be less abrasive and mean. So I hear, I don't see her anymore. She falls a lot, but it's due to the fact she refuses to use her walker, she shoves a chair around her house. Because that looks less 'old'. I agree, it makes her look demented.

Anyway, it's a crapshoot, finding the right med to help with anxiety in the moment. A lot of AD's have that qaulity, but take a long time to help.

Benzos (Xanax, Klonopin, Ativan, etc) trashed both of my parents in terms of balance. But they were on them long-term (middle-aged into old-age). They work well for sleep and anxiety. You can become physically dependent very quickly upon them and withdrawl can be nasty. For my mom, withdrawl is hallucinations and delusions, pretty much mimicking dementia. My dad got put in a memory care facility where he lived for three years and died. I still wonder if he had dementia (actually) or if his dependence on Klonopin made him so delusional. Mom's falls over the past 10 years have resulted in broken hand, shoulder, spine & ribs. She's had multiple head injuries as well.

All medications that cause sedation will increase fall risk. Remember that all medications affect the elders more intensely. They have a slow metabolism and a more sensitive body. They require very small doses of everything.

With ALL medications there are risks involved.
You have to weigh the "Benefit VS Burden" when deciding what to do.
Have you talked to the doctor about the medications that might work? (you do not mention a specific dementia and some dementias contraindicate some medications)
Falls happen. You can do what you can to minimize them. But if one happens it is not your fault.
The use of a walker can minimize them. A cane might help as well. Good shoes. Getting rid of throw rugs, making sure there is nothing on the floor that can pose a hazard.
An assessment from a PT or OT can help as well.

Unfortunately, almost all of the medications meant to relieve anxiety will increase fall risk. Discuss this with the ordering MD so that something might be worked out the best it can be. Wishing you good luck.