A chemical restraint is any drug used to control behavior in a manner not required to treat the medical or psychiatric condition. A Human Rights Watch (HRW) report released February 5, 2018, (“They Want Docile; How Nursing Homes in the United States Overmedicate People with Dementia”) reports that in an average week, over 179,000 U.S. nursing home residents are given psychotropic drugs, not because there is a diagnosis of mental illness, but rather to sedate the resident. That is chemical restraining.
Antipsychotic drugs can be helpful for people diagnosed with illnesses such as schizophrenia; however, in nursing homes they are too often used for their sedative effect. And what’s worse, when these drugs are used outside their FDA-approved manner, they can do more harm than good.
As far back as 2005, the FDA issued a “Black Box Warning”, its strongest warning, notifying healthcare professionals that antipsychotic drugs are not indicated for treatment of dementia-related psychosis and increase the risk of death. In 2008, the FDA stated that both conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychosis. Yet hundreds of thousands of nursing home residents with dementia throughout the country receive these drugs on a daily basis.
These drugs are often prescribed without first obtaining informed medical consent. To meet this legal requirement, the patient (or their representative) must be informed of the risks and benefits of the proposed drug, as well as alternatives to it. It is the doctor’s responsibility to obtain informed consent, and an explanation by a nursing home employee will not suffice. Absent a medical emergency, failure to receive informed consent prior to administering any medication may be deemed battery.
So, what can we do? First, know that, according the HRW’s report, only 5-10% of nursing home residents in Southern Oregon receive antipsychotic drugs (this figure does not differentiate between residents with or without a diagnosis for which the drug is appropriate). Second, know your rights, both as a patient and as an advocate for someone unable to speak for themselves. Do not consent to the use of psychoactive drugs unless certain all other care treatment options have been exhausted. Insist on being provided written information on the adverse consequences of the proposed drugs, including any “Black Box Warnings”. Consider a second opinion from a trusted physician if any doubts remain. Periodically request a complete list of current medications from the facility and review them with a trusted physician.
Psychoactive drugs should always be the last resort for treating the symptoms of dementia. The signs of a good nursing home include treating the underlying medical problems, relieving pain, and doing everything possible for the residents to feel comfortable and at peace. We will explore this “culture of care” more deeply in the next article.
For further reading:
RT News Report
Human Rights Watch Report
This is a subject in which I was quite involved in California. I will write more on it in the coming weeks. Here is a video to start off the conversation of this very important subject.
Oversedation in Nursing Homes across the Country
As the Baby Boomers turn 65 (at the rate of one every 10 seconds), more and more Americans will find themselves faced with some potentially difficult realities. Among those is recognizing when a loved one may need help at home. It is important to communicate with your loved ones and let them know why you are worried and that you want to help. The best solutions will be the ones worked out together.
Here are some signs that may indicate someone needs help:
Are appointments missed or bills not getting paid? Are common objects being put in illogical places. Perhaps medication is being incorrectly or not at all.
If you notice any of these, an assessment (both medical and cognitive) may be in order to determine what is going on and to come up with some options. Knowing the cause means effective treatments can be put in place, keeping your loved one safe.
- Difficulty Getting Around
Are your loved ones having trouble moving around or getting in and out of chairs? A two-story house could be problematic and create a much higher fall risk. Check for slippery tiles and furniture that creates obstacles.
A cane or walker may be all that is needed. In some cases, modifications to the house may be possible. The goal is not get your loved one to leave the home, but rather to come up together with viable options that keep them safe.
- Unusual Amount of Clutter
Is there dirty laundry or unopened mail in a home that is historically meticulously clean? This could be a sign of cognitive decline, or simply that the house is getting to be too much to handle. A conversation could help determine what is needed: a housekeeper, gardener, or a more significant geriatric makeover.
- Change in Personality
Are there changes in personality? Are your loved ones accusing people of taking their things, or exhibiting other paranoid behavior?
This could be a sign of dementia. An appointment with a medical doctor for a cognitive assessment could be important to establish a base line from which to gauge any further decline. If dementia is diagnosed, that in itself does not mean that your loved one cannot participate in the decision-making process; the severity of the dementia will have more of an impact on their inclusion in the conversation. However, dementia will mean that at some point they will not be able to make decisions and now is the time to make certain all legal and medical documents are in order.
It is important to remember that needing assistance does not necessarily mean leaving the home. It may be that extra help in the home environment is all that is needed to keep your loved one safe and healthy. A care manager or elder law attorney may be able to assist with determining what extra services are needed and where to look for help.