I am often asked about the use of medications to help with adjustment to memory care or skilled nursing facilities. For example, I was asked “would my mother do better in a memory care unit if she was given Xanax.” This is a logical and compassionate question. As with most persons who need the total services, her mother is mildly agitated and trying to plan how to escape now that she lives in a locked memory care unit. The intent of the question is to find out if use of a calming medication makes the adjustment easier.

The issue of adjustment is complex and involves both the memory impaired person and their caregiver (spouse or child). In my experience it often takes several weeks or months to actually get settled with a move and all of the associated changes. Who wouldn’t rather keep living in their home? Many in these facilities spend an adjustment period where they pack and unpack their clothing each day. Furthermore, the need for placement negates easy explanations. By the time placement is needed, the severity of the dementia negates those complex abilities of comprehension, reasoning, and accurate self perception. Indeed, if the person could accurately see their level of decline, they would ask to be moved into the facility.

Is use of the medication for staff convenience? Staff convenience is not a good reason to use medications. Staff in most facilities should be trained to handle many instances and types of agitation without the need to resort to drugs. Is the medication being used because either the resident of the facility or staff at risk of harm from the agitated resident for staff safety? If so, at least brief use of a medication can be quite helpful in many cases.

Is the medication being requested to assuage guilt over placement? I have never seen a person placed too early in a memory unit. Despite this, most caregivers will suffer from feelings of guilt, second thoughts on placement, and complex grief. Also, the caregiver is in difficult position after placement where the resident does well all day with activities. But visitation from family triggers the natural desire to be taken home, which of course breaks your heart. This is part of the adjustment for both of you and will usually take weeks to unfold.

Finally, there is no evidence that I am aware of that addresses the issue of whether medications speed up the adjustment to placement or makes it easier. If we compare the feelings after placement to grief, there are to date few studies suggesting that use of medications either makes grief easier or resolve more quickly. In some instances medications interfere with adjustment.

Whether to mediate to help adjustment to locked memory units has no universal answer. It depends on multiple complex factors. In most cases that I have encountered, it appears best to avoid a knee jerk use of medications like Xanax, antiseizure drugs, or neuroleptics. Rather, use stimulation, redirection, and reassurance first. Only use medications when nondrug therapy fails or there is danger. Finally, reassess after time to determine if the medication is still needed.