An interesting read this weekend is the Washington Post article, Why are nursing homes drugging dementia patients without their consent? Improvements have been made in this area, but sadly they note that on the average, more than 179,000 residents in nursing facilities are administered antipsychotic drugs each week without an appropriate diagnosis. Many of these drugs were developed to treat schizophrenia, not dementia. Research indicates that there is no one drug therapy that is proven to control dementia related behaviors. Each individual is different and requires customized disease management. So why are these drugs used? In some cases these drugs are used for more challenging individuals to sedate and make them more compliant. Functionality, quality of life, and overall health however, are at times sadly compromised as a result of this type of practice.
The most important points to note from this article are:
1. Those with dementia do not have capacity and therefore cannot consent to procedures or medication regimes. They rely solely on their decision makers to make good choices for them. This is why memory care specifically should only be used when truly needed and appropriate!!! And a dementia diagnosis should not be thrown around in a trivial manner. Realize what you are taking away from someone when they are given a diagnosis of dementia; you may be taking away their rights. Many family members and even healthcare providers confuse age related cognitive impairment for dementia. In addition, there is no valid tool for assessing cognition in those with visual and hearing impairments.
2. Many facilities do not properly obtain consent for medications with decision makers- they simply call the family to inform them once the medication has been ordered and started. If your family member is in a facility ask questions about the medications being prescribed / started, the purpose, the side effects, and why needed. Ensure that you are truly providing knowledgeable input into their care and medication regimes. Ensure that you are acting within the guidelines of their expressed wishes!
3. An important quote regarding antipsychotic regimes from the article, "There’s no proven link, but the trend does suggest that some homes seek false diagnoses to avoid red flags with the use of these medications. A second concern, recognized by CMS, is that nursing homes are simply replacing this closely watched class of psychotropic medication with other types of sedating drugs with similar health risks." I have seen during quality of care reviews incorrect diagnosis on some client MAR's that I have then had corrected in some facilities. If you are remotely managing the care of a family member you may want a care manager to do intermittent quality of care reviews for this reason.
Link to article below: