CHICAGO, IL – Nursing homes overmedicating residents is just an example of the horror stories you tend to hear about these type of long-term care facilities. You hope that this never happens to your loved one; however, it happens all too often.
With the U.S. population aging rapidly, elders now account for one in seven Americans, totaling nearly 50 million people over the age of 65. With more than 1.4 million people living in nursing homes across America and nearly 50% being diagnosed with Alzheimer’s disease or dementia, it’s important to understand how your loved one could be a victim of overmedication.
A 2018 study found that in an average week, nursing facilities in America administer antipsychotic drugs to more than 179,000 people who do not have a diagnosis to receive approved drug. Antipsychotics are usually given without free and informed consent, which requires a decision-based discussion on the purpose of prescribing the medication, risks, benefits, and alternative medicine that may be better suited for the resident.
According to the U.S. Government Accountability Office (GOA) analysis, nursing home facilities often use antipsychotics to control common symptoms of dementia or Alzheimer’s.
Aurora Suarez, a Texas native, described her experience visiting her sister at her Texas nursing home as, “They give her so much [medication], she sleeps through the lunch hour and supper. They give her medication to sedate her on the days of her shower: Monday, Wednesday, and Friday.”
Some symptoms of these diseases may be relived by using these drugs; however, evidence from clinical trials show the benefits of treating these symptoms with antipsychotic drugs is weak. The U.S. Food and Drug Administration (FDA) has not approved dementia or Alzheimer’s to be treated with these drugs and has discussed the dangers of using it for other purposes.
A study published by the U.S. National Library of Medicine National Institutes of Health found that on average, antipsychotic drugs nearly double the risk of death in older individuals suffering from dementia.
Antipsychotics have a sedative effect that drives the prevalence of use in people with dementia in the United States has a long history. This drug alters a persons consciousness and their ability to interact with others. It also makes it easier for nursing homes that are unstaffed. Many direct care workers are inadequately trained in dementia care which makes it easier for them to manage residents. Experts have said they think many nursing homes staffing levels are well below the minimum needed to provide appropriate care to residents.
Nursing homes turn to antipsychotic drugs because of the symptoms of dementia such as agitation, irritability, aggression, delusions, wandering, disinhibition, and anxiety. These symptoms become challenging and frightening to residents and their caregivers, which is why the prevalence is so high.
One nurse from Kansas mentioned her facility was using antipsychotic drugs at a rate of 55%, but now only use it for people with a diagnosis.
“They have a better quality of life because they are not sedated,” the nurse said.
A For-Profit Industry
One long-term consultant mentioned the cost-benefit analysis in the long-term care industry. Since nursing homes are typically a for-profit industry, they try to control most aspects of the residents’ life. Presumably, healthcare providers would be more inclined to meet the minimum health and safety standards in place if it costed them dearly to do so.
“If the fine is $100,000, then they’ll hire the three nurse aides who will cost the same amount.”
Dangers of Antipsychotic Medications
As with any medication, there are side effects, especially if the medication was not specifically prescribed to help relive your symptoms.
Older adults are highly vulnerable to the side effects of these drugs. Adults older than 70 are 3.5 times more likely than younger individuals to be admitted to the hospital due to adverse drug reactions that are associated with antipsychotic medications, according to NCBI. The risk for reactions increases dramatically with the number of medications used with increasing age.
Other risks of antipsychotics include: movement disorders, diabetes and risk of a stroke. Data from meta-analyses of randomizes trials and observational studies show the drug increases in mortality.
Under the Nursing Home Reform Act of 1987, the government is required to protect the rights of residents. Many advocates say the government has failed our most vulnerable population time and time again. In fact, the Centers for Medicare & Medicaid Services (CMS) established the National Partnership to Improve Dementia Care in Nursing Homes in 2012 to acknowledge the ongoing issue.
This move made a difference, reducing the use of antipsychotic drugs by 35% in nursing home facilities.
CMS agrees that more can be done – and insists it will be.
Reports and studies suggest the government can and needs to do more to protect this population by ending the inappropriate administration of antipsychotic medications by enforcing regulations and penalties for nursing homes who violate these in place. They can also improve inspections, require inform consent from resident’s, and ensure adequate staffing and training in long-term care facilities.
Federal and State Regulations on Informed Consent
Federal regulations require individuals to be fully aware and informed about their treatment and the right to refuse treatment. Illinois state law requires facilities to obtain “voluntary informed consent, in writing, from a resident or the resident’s surrogate decision maker before administering or dispensing a psychotropic medication to that resident,” (210 ILCS 45/2-106.1). However, many nursing facilities make an effort to do so.
If a nursing home staff member administers a drug under nonconsensual use and without appropriate medical indication are violating human right norms. The drugs are intended to be used as a chemical restraint, which could constitute abuse under domestic law and cruel, inhuman, and degrading treatment according to international law.