Antipsychotics and overmedication of residents in nursing homes
When I hear stories of nursing home residents who are overmedicated1, it takes me immediately back to my mother’s experience. My mom had a stroke in 1998 and 2 weeks later had a perforated bowel, which caused her a rapid decline until it was treated by surgical repair.
She had type 2 diabetes and high blood pressure for several years as a result of life-long obesity and weight control struggles. In any case, as I mentioned in my last post, she had many complications after that surgery, some from medical error, including another smaller stroke while at rehab.
After a few months, rehabilitation was competed as best as possible and she was able to return home with services, doing pretty well for about a year. Then she likely had another stroke, which made her care unmanageable by my dad alone. After trying live-in care and 24-hour shift-based nursing aid care, my mother finally agreed to go into a nursing home. Home-based care was just too much for my dad. My brother and I lived out of town, had jobs and families, and could only help on occasion. We had been looking and thought we found a suitable place. My brother had a long talk with the Director of Nursing and we felt confident that she would be well taken care of.
The Director of Nursing left not long after my mom was admitted, and things were never the same at that nursing home. Staffing became inadequate, and there were many temporary staff members working there, we learned when talking to staff who cared for my mom. She told us she didn’t want to move, despite repeated offers and discussions. Change, no matter how positive, is always difficult.
At some point during this time, she was put on risperidone, trade name Risperdal, which is an antipsychotic. I think they told me it was to help her appetite! I don’t remember any more how long she was on that medication because I questioned it, but it wasn’t known at that time how badly it affected the elderly—it was still fairly new, and there was documentation that it was helpful for problematic behaviors.2
We got an opportunity to move her to another nursing home soon thereafter, and by the time of the move, she was having some hallucinations and told me over and over she was not crazy. She also had had repeated urinary tract infections, further kidney function decline, and other cognitive issues, which I later learned may have occurred as a result of the drug’s use, as well as the neglectful care. It was really sad, but just one part of a long and harrowing experience.
I never knew whether the hallucinations were from the medication or from early Alzheimer’s disease. She was never diagnosed with Alzheimer’s while living, but had signs of it noted in her autopsy when she died.
The difference in the two nursing homes was like night and day. The new one was not as new, but the care was nothing short of phenomenal. There were more nurses and aides and they really took care of the residents and treated them as the individuals they were. She was taken off unnecessary medications and never had another hallucination, which made me wonder again why she had been prescribed Risperdal in the first place. She looked and felt better and began to trust her caregivers again. Fortunately, her trust was not misplaced this time.
What happened to my mom in 2000 is still happening now.3 While there has been some decrease in unnecessary use of antipsychotics through a campaign by the Center for Medicare and Medicaid Services, every family has to pay attention to the ongoing details when a family member needs nursing home care.
Adequate staffing with adequate training can make a huge difference, as it did with my mom. Behavior therapy such as redirecting or tailoring a resident’s environment to his or her needs has been shown to be very effective. Music therapy or playing familiar music can have a very calming effect. And then there is just listening to and problem solving environmental causes of problematic behaviors among residents.4 These kinds of interventions greatly reduce the need for medication. And if medication is used, it needs to be at the lowest possible dose for the shortest period of time, with scheduled re-evaluation.
Attention to this problem among many others is critical as we face the “silver tsunami” ahead. Education, training, and vigilance, will be required to keep our elders safe in the coming years.
- Jaffe, I. and Benincasa, R. (December 8, 2014). Old and Overmedicated: The Real Drug Problem in Nursing Homes. Retrieved from: http://www.npr.org/blogs/health/2014/12/08/368524824/old-and-overmedicated-the-real-drug-problem-in-nursing-homes
- Maguire, G. A. (October, 2000). Impact of Antipsychotics in Geriatric Patients: Efficacy, Dosing, and Compliance. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181134/
- Goodwin, J. (July/August 2014). Drug Abuse: Antipsychotics in Nursing Homes. Retrieved from: http://www.aarp.org/health/drugs-supplements/info-2014/antipsychotics-overprescribed.1.html
- Browning, D. (December 20, 2013). Listening to Elderly Cuts Use of Costly Medications. Retrieved from: http://www.startribune.com/lifestyle/health/236822161.html
