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Taylor-Stein: Make 'least drugging' a nursing-home norm

Ventura County Star
Sylvia Taylor-Stein is executive director of Long Term Care Services of Ventura County Inc.'s Ombudsman Program.
April 23, 2011

Frail and vulnerable residents of nursing homes throughout California are being dosed with powerful anti-psychotic drugs, leading to painful spasms, tremors, lethargy, a higher risk of harmful falls, infections and even death. Making matters worse, the drugs often cause behavioral problems, leading to even more drugs.

In many nursing homes, anti-psychotics are the drug of choice to subdue residents with dementia. More than 25,000 California nursing home residents — one of every four residents — are given these drugs each day. Many residents are drugged without their consent and without a legitimate medical reason for their use.

Consider what the Food and Drug Administration had to say in a 2009 alert:

Elderly patients with dementia-related psychosis treated with conventional or atypical anti-psychotic drugs are at an increased risk of death.

Anti-psychotic drugs are not approved for the treatment of dementia-related psychosis. Furthermore, there is no approved drug for the treatment of dementia-related psychosis. Health care professionals should consider other management options.

The FDA has also issued its most dire warning — known as a black-box warning — that anti-psychotic drugs cause elders with dementia to die.

Make no mistake. Anti-psychotic drugs do not treat dementia. They are a treatment for schizophrenia, a rare and serious form of mental illness.

Although some nursing homes and assisted living facilities use these drugs only as a last resort, others use them routinely to chemically restrain residents with dementia.

In the fourth quarter of 2009, anti-psychotic drug use in nursing homes in Ventura County ranged from 8 percent at one nursing home all the way up to 30.6 percent at another. It is interesting that both of these nursing homes are within a couple of miles of each other and nearly have the same number of residents.

Why such disparity? It is an interesting question, and bears looking into.

There is a better way. Caring for individuals who suffer from dementia is difficult, but progressive providers throughout the nation are demonstrating great success in addressing behavioral symptoms of dementia with very little or no use of anti-psychotic drugs.

These facilities use good nursing practices to identify and respond to untreated pain and infections that often go undetected in elders with dementia, and common sense techniques to make their lives more comfortable. A little caring and compassion can go a long way.

As ombudsman, federal law requires us to speak up about any issue that affects residents in long-term care. This could be legislation, education or anything that affects their quality of life, including misuse of medications. Residents in nursing homes and their representatives have the right to know what medications they are receiving, to be informed of their side effects and to accept or refuse them.

Elderly people in Ventura County nursing homes have a legal right to live in the least restrictive environment as possible, including freedom from chemical restraints. The Toxic Medicine Symposium we held last month served to help facilities, caregivers, regulators and community leaders set a new direction and a better standard of care for elders with dementia.

Please join us in making "least drugging" the norm, rather than the exception in Ventura County nursing homes.