© Imelda Maurer, cdp January 6, 2008
I keep seeing it.. Whether it is a newsletter, a professional journal, a TV news story, or just this afternoon a well-written, documented article on the Internet: (http://www.therubins.com/homes/vocal.htm) The article refers to a study I also mentioned in a blog post almost a year ago (January 14, 2008). The study involved 86 individuals being treated for "behavioral problems". One third were given Risperdal; one third another anti-psychotic and another third, a placebo. After a month "behaviors" had "improved". The group with the most significant positive changes was the group receiving the placebo.
There is a stream of information about the use of antipsychotic drugs used on the elderly as a way to address what caregivers mistakenly call "behavioral problems." Behaviors among persons with dementia are not problems. Dr. G. Allen Power, Medical Director at St. John's Home in Rochester, NY believes that the use of terms like "behavioral problems" or "managing difficult behaviors" reinforces the medical view that the 'problem' rests with the person with dementia. Rather, he says, these events should be seen as "symptoms" that occur, not because of a failure of the individual, but rather because of a failure of the care environment to adequately identify and meet the person's needs. This statement is so core to the effective care of persons with dementia, I want to state it again: . . . these events should be seen as "symptoms" that occur, not because of a failure of the individual, but rather because of a failure of the care environment to adequately identify and meet the person's needs.
The Center for Medicare and Medicaid Services indicate that nearly 21% of nursing-home residents who don't have a psychosis diagnosis are on these anti-psychotic drugs. It is a way to sedate a person – in the short run --- but without addressing the issues at hand and at the same time setting the stage for complex negative side effects from the drug.
Three of the most frequently prescribed (I should say mis-prescribed) are Risperdal, Zyprexa and Seroquel. All three of these drugs carry "black box warnings", mandated by the FDA, which indicate that 'elderly dementia patients taking these drugs are at higher risk of death.'
Side effects of these drugs include weight gain and stroke, sometimes resulting in death. There is sometimes an increase in blood sugar levels, intolerance to changes in ambient temperature. A most obvious side effect is that of sedation.
Definition of off-label use of a drug.( From my post on January 14, 2008): When a drug has been developed and approved by the FDA for a certain disease or disorder, but a health care provider prescribes it for a condition other than that covered by the drug’s FDA approval, the practice is called off-label use. Physicians attending nursing home residents in far too many cases prescribe any of these antipsychotic drugs as all-purpose tranquilizers
As I write this, I wonder if the broad, expensive, ineffective, harmful and widespread use of off-label antipsychotic drugs among the most vulnerable in our society is a subtle or not-so-subtle manifestation of ageism. Or is it because in our long-term-care system we don't take the time to really know each individual, know him or her as an individual, not just an old person --- who is going to die anyhow ---. Do we as a society, as Dr. Bill Thomas suggests, view nursing home residents as racing toward the exit ramp of life? Of course none of us subscribes to these views consciously, but are they at work in our society and institutions at a subconscious level?
Tuesday, January 6, 2009
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ReplyDeleteI saw a woman given haldol in the nursing home where my mother was. She had dementia and wandered around. Then she only sat. Then she took to her bed and then she died. She didn't hurt anyone, just irritated the nurses and aides.