Wednesday, August 15, 2018
From the Washington Post, a report by attorney Hannah Flamm, a self-described immigration attorney, on the misuse of antipsychotic drugs in nursing home from her time as a fellow at Human Rights Watch:
A year and a half ago in a Texas nursing home, I met an 84-year-old resident with dementia named Felipa Natividad. Her sister, Aurora Suarez, told me that the staff dosed Natividad with Haldol, an antipsychotic drug, to ease the burden of bathing her. “They give my sister medication to sedate her on the days of her shower: Monday, Wednesday, Friday,” Suarez said. “They give her so much she sleeps through the lunch hour and supper.” A review of Natividad’s medical chart confirmed the schedule.
Suarez said she had given her consent to use the drugs because she feared that the staff would not bathe her sister enough if she refused. But when Suarez saw the effect they had, she had second thoughts. She expressed them to the nursing home, but Natividad was taken off the antipsychotics only after she was placed in hospice care. She died a few months after my interview. Her family, seeing her in a reduced state and unable to communicate, wondered whether the drugs had compounded the losses associated with dementia; Suarez thought they contributed to her sister’s decline. “She gets no nourishment,” she told me not long before Natividad died.
The use of antipsychotic drugs as chemical restraints — for staff convenience or to “discipline” a resident — has a long history in nursing homes. . . .
Our thanks to several readers who sent us links to this article! For more, read Why Are Nursing Homes Drugging Dementia Patients Without Their Consent?
As with many recent stories about use of drugs with dementia patients, I tend to caution against any simplistic answer and -- sometimes -- I plead for more research into medications that "could" work, with safer outcomes. Recently I chatted with staff at a care center entirely devoted to non-restraint policies and behavioral health approaches to dementia care.
Despite their experience, they had not yet found a solution for a resident who was in the throes of a particularly difficult stage of his disease, causing him to be awake, walking, for long hours, with ever growing agitation. Even with one-on-one attendants, he would not sit to eat meals. Other residents would react to his agitation, and the agitation seemed to have a magnifying effect on them, with a potential for explosive results. It was exhaustion, not drugs, that would briefly interrupt the man's cycle, only for it to begin again when he awoke.
In the above article, a source from the American Psychiatric Association is quoted as concluding that antipsychotic drugs offer “at best small” potential benefits (such as minimizing the risk of self-harm in people with extreme agitation), while “on the whole, there is consistent evidence that antipsychotics are associated with clinically significant adverse effects, including mortality.”
And yet, to my non-expert eyes, the unmedicated cycle of extreme agitation and overwhelming exhaustion I witnessed would also be associated with "significant adverse effects," including "mortality."