"It seems pretty clear from the research that all too often these atypicals are being used to calm people down," said Thomas Snedden, director of Pennsylvania's prescription-drug programs, known as PACE, for low-income residents ages 65 and older.
Laws trying to ensure proper use of psychiatric drugs require that nursing homes carefully monitor them, checking to see how patients respond and trying to reduce the dose or wean patients off them.
Doctors and other experts on the elderly believe atypicals fill an important niche but recommend using them with extreme caution, a difficult challenge in an era of busy families and overworked nurses and aides.
Elaine Leventhal, director of the Gerontological Institute at the University of Medicine and Dentistry of New Jersey, said caregivers should try to manage behavior before turning to medications. She recommends that the family stay for dinner the day a relative is admitted to a nursing facility and visit as often as possible to ease the transition.
If patients become upset, staff should try to figure out why, Leventhal said. Is a roommate screaming? Does the patient need to do something other than sit all day?
Kathye Wiggins, of Yardley, was the kind of mother who led Girl Scout troops and coached softball teams.
"She was one of my best friends," said her daughter, Corri Workman. When Wiggins began forgetting things in her late 40s, her family dismissed it as a symptom of menopause.
Then, on a trip home to Ohio after her mother died, Kathye couldn't find her way back to the hotel, so her husband, Bill, asked her doctor for a thorough checkup.
When the doctor asked Kathye to count backward from 100 by threes, she stopped at 97. In 2001, doctors at Penn's Memory Center diagnosed Alzheimer's disease.
She was 53.
"She was so young, you kept hoping they were wrong," Workman said.
Bill Wiggins had one goal - to continue caring for his wife in their home.
"She'd do it for me," he said simply as Kathye sat silently on their couch, vacant eyes gazing at the floor.
He doesn't believe that even the best nursing home could take care of her properly. She wanders. She no longer speaks. She can't feed herself or tell anyone if she has gone to the bathroom.
Bill Wiggins found caregivers to help while he worked out of his house as a salesman. While he was in Florida for business in early 2007, Kathye, who had been growing increasingly aggressive, started thinking that the woman caring for her had broken into the house. She attacked her.
The aide called Workman, who was 32 weeks pregnant with twins. Workman dashed to her parents' home, calmed her mother down and, that evening, went into labor. Workman doesn't know whether the stress contributed to the premature births. Her twins are fine now.
For Bill Wiggins, it was a breaking point. He had pressed on when the caregivers he hired did little work. He had lived with the stress of wondering how he would continue to pay for Kathye's care. This was too much.
Kathye's doctor, Jason Karlawish of Penn's Memory Center, was frustrated, too. He reserves atypical antipsychotics for the most severe cases. He always tries to rule out alternative physical explanation for the patient's symptoms. Diseases such as pneumonia, for example, can make an older person delusional.
For Kathye, Karlawish believed there was no other choice.
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