Overmedicating the Elderly in Skilled Nursing Facilities
When relatives are no longer able to help their elderly loved ones on a regular basis, skilled nursing facilities (SNFs) exist for these patients who need continual and professional nursing care. Many of these facilities perform this service well and offer a great alternative for families needing assistance. However, some facilities turn to overmedicating their patients to control them.
These nursing facilities that overmedicate do so with the intention of cutting costs and making life easier for their own staff. The facilities may heavily sedate patients instead of caring for them, condemn their remaining life to inactivity, and deprive the elderly of human interaction in their fragile years. In short, the quality of life they promised might be sacrificed for the sake of efficiency and low cost.
Overmedication has more insidious effects than forcing patients to be ‘manageable’ for the staff. It also has been shown to deteriorate cognitive and mental capacities. Overmedication can change human behavior. Using the wrong amount of a medication can leave patients confused and detached, and even uninterested in life itself. In extreme cases, it shortens the remaining life span of a resident. When this is done, it isn’t just inhumane and immoral, but also illegal.
A common excuse for overmedication is the claim that the patients are agitated, violent, unruly, or something else along those lines. Facilities sometimes employ antipsychotics which often aren’t part of a treatment. Antipsychotics are used to tranquilize patients, not to cure them. They have short-term effects. When they are used for the sake of staff’s own convenience, the practice becomes a crime.
Medication is already a delicate issue even when it isn’t overdone.
Prescribing medication is a complex matter. Doctors have to take into account interaction between multiple types of medication, side effects, appropriate use, etc. Even when they do their best at evaluating the harms and benefits of a medication, it might still not be enough to eliminate all the risks. Sometimes preventing these complications can become more problematic than curing the actual disease.
In 2011, more than 35% of community-dwelling adults aged between 62 to 85 years used at least five prescription medications. The same study shows that 15% of older adults are potentially at risk for a major interaction between multiple types of medication. The figures are higher among the elderly in skilled nursing facilities. Polypharmacy – the use of four or more medications by a patient – has become a serious problem. If we add overmedication to the picture, the gravity of the situation becomes more apparent.
Warning signs to watch for:
Unless one is an expert on the subject, it is hard to be absolutely sure whether a particular situation is an over-medication case or not. However, there are some signs that you should be on the look out for. Low employee to client ratio is a common indication that overmedication may be occurring. Understaffed facilities are far more prone to overmedication than the regular ones. Instead of paying for additional employees, some would opt for inducing sleep and inactivity. Antipsychotics and sleeping pills can become dangerous weapons in the wrong hands.
Over several visits if you find your loved ones in sleeping, or if you observe that they’re struggling to stay awake, or they’re slurring, take note. Finding them drowsy or asleep once in a while can be a normal occurrence. However, if it becomes a pattern, this can be a sign that unnecessary drugs are being forced upon the patient. If you have a concern, ask for the clinical records of your loved one. Do not be afraid to request an explanation for every medication administered. If there is something that is not part of their routine medication, it could a cause for worry. Most overmedication cases occur when drugs are given as needed, not as a part of a long treatment process.
Aside from that, the facilities are under the obligation to inform the relatives of the elderly about any medication change, including new dosages. Doctors should give their reasons for the change to the relatives of the patient. Families have the right to demand from the doctor an explanation why they’ve decided on a specific medication and dosage.
During a meeting with the staff to discuss the condition of your loved ones, you might be overwhelmed by the number of documents to review as well as the medical terminology used. Sometimes there is more than one staff member present in the meeting. These factors can make it more difficult for us to make sense of what is happening. In addition to this, people aren’t always allowed to see the doctor directly. Instead, they first need to pass the gatekeepers – nurses.
In the event that you are confused, it is better to seek the assistance of a Consultant Pharmacist. Obtain the accurate medication and medical history of your loved one and show it to the Consultant Pharmacist. Consultant Pharmacists screen them for appropriate dosages and potential interactions. Additionally, checking the American Geriatrics Society’s (AGS) list of potentially harmful medications for older adults can also be a great help.
If your fears are confirmed, it is crucial to tell the authorities and seek the help of a qualified attorney to fight against the abuse.
There is a thin line between under-medication and over-medication.
It is important to monitor the condition of your loved one related to medication. However, when trying to be helpful, we might inadvertently cause more pain to our loved ones. We should never forget that medication is almost always necessary for the elderly in nursing facilities. Medication is meant to increase their quality of life and hopefully, to prolong their lives. Antipsychotics exist for a reason – to tranquilize those in pain. Before refusing to allow medicating our loved ones, the situation should be carefully evaluated.
In many cases, increasing the medication over time is inevitable. In the case of dementia, as the condition progresses the brain usually needs more or different medication. Time doesn’t heal old age. Therefore, under-medication can be equally harmful. If the proper medication isn’t administered, unwanted consequences such as screaming, falling, throwing oneself out of bed, cursing, combating the staff, and disturbing other patients become dangerous possibilities.
Convulsive pain, shrieking, agony, and uncontrolled anger are heartbreaking sights neither patients nor their relatives deserve to witness. Before coming to a firm decision, we must consider all the caveats of the problem. Life is never a plaything to leave to a few professionals and individuals to decide what to do with it.