A Christmas Message

LeadingAge offers a daily news clipping service as one of its membership benefits. So each day I get an e-mail with links to a half dozen or so current news articles that relate to aging and aging services. This morning one of the articles is from an article originally in The Boston Globe, but quoted from the San Francisco Chronicle. The article is about lack of enforcement for inappropriate use of antipsychotics on nursing home residents in Massachusetts, particularly those living with dementia. It's not a happy Christmas Eve message, but one that too often is found in newspaper and journal articles -- reflecting a tragic reality for too many elders in our country.

I quote just one sentence here, but include the link to the article also:

“A few reports detailed cases when residents were so overmedicated

they were unable to open their mouths to eat or do much but sleep.”

I venture to say that in too many “typical” traditional nursing homes it would not be unusual for a visitor to observe one or more residents at the dining room table so sedated that it was difficult for staff to assist him/her with the meal. Do we just smile such scenes away with some misguided, “sweet” myth that elders just sleep more?

Federal and State regulations forbid use of antipsychotics for the “treatment” of “behaviors” for good reason. Such use does not address the issues at hand, does damage to the resident physically and psychologically and is a cruel imposition of “treatment” – fierce and deadly chemical restraints – on helpless individuals. It is abuse clear and simple and must be stopped.

Not a pleasant message to post on Christmas Eve. However I am reminded of Howard Thurman’s message, “The Work of Christmas.” I offer it here. We must do what we can to “heal those broken in spirit” and to “radiate the Light of Christ . . . in all that we do

When the song of the angels is stilled,

when the star in the sky is gone,

when the kings and princes are home,

when the shepherds are back with the flocks,

then the work of Christmas begins:

to find the lost,

to heal those broken in spirit,

to feed the hungry,

to release the oppressed,

to rebuild the nations,

to bring peace among all peoples,

to make a little music with the heart…

And to radiate the Light of Christ,

every day, in every way, in all that we do and in all that we say.

Then the work of Christmas begins.

Newspaper article quoted can be accessed at:

http://www.sfgate.com/news/article/Report-Mass-rarely-nixes-nursing-home-sedatives-4141901.php

“Would you give your mother . . . ”

Later today the Missouri Quality Improvement Organization is providing a webinar for those involved in long-term care. The topic is antipsychotic medication use in the elderly. The phrase that I have used as the title of this post heads one of the slides for this presentation and goes on to list the serious negative side effects of all categories of antipsychotics. It’s scary, really to read all the side effects in one place at one sitting.

A few thoughts come to mind about this. When antipsychotics are used to “treat” “behavioral issues” as a result of dementia, the drugs don’t work! The drugs don’t address the “cause” of the “behavior.” So in addition to not working, the resident living with dementia suffers a myriad of negative side effects, not the least of which includes strokes and as much as a 1.7 fold increased mortality.

My second thought: no, I would not give that to my mother. Who would, really, if one is informed about these issues. This surfaces the importance of being fully informed. Within birth families, when a parent begins to show signs of increased frailty or cognitive disabilities, the adult children are often bewildered. It’s all a new experience; they have little or no knowledge of the aging process or of the avenues of appropriate services that can and should be provided. Often times, there is an admission that when the second parent needed more services, the adult children were more knowledgeable and comfortable in providing them or seeing that they were provided. The adult children have through their previous experiences become informed about appropriate issues: aging process, medications or other treatments, and how to make a decision of informed consent in keeping with the wishes of the parent.

And thirdly, for those of us who live in communities of Religious Institutes, we shouldn’t feel so flustered. Seeing our mentors, our congregational giants, and our friends move along this path, it is not so new to us. With our experience, with our growing knowledge of the intricacies of aging, normal or with more chronic disorders, we should be able – in a very informed way – to companion our Sisters wisely, gently, compassionately and competently.