Death By Medicine - Elders

[Guest guest]

http://www.garynull.com/documents/iatrogenic/deathbymedicine/DeathByMedicine7.ht\

m#WAREHOUSING%20OUR%20ELDERS

 

 

Death by Medicine -7

Gary Null PhD, Carolyn Dean MD ND, Martin Feldman MD

Debora Rasio MD, Dorothy Smith PhD

October 2003

 

Note: The information on this website is not a substitute for

diagnosis and treatment by a qualified, licensed professional.

 

home previous next

 

WAREHOUSING OUR ELDERS

 

It is only fitting that we end this report with acknowledgement of our elders.

The moral and ethical fiber of society can be judged by the way it treats its

weakest and most vulnerable members. Some cultures honor and respect the wisdom

of their elders, keeping them at home – the better to continue participation in

their community. However, American nursing homes, where millions of our elders

die, represent the pinnacle of social isolation and medical abuse.

 

Important Statistics about Nursing Homes

 

1. In America, at any one time, approximately 1.6 million elderly are confined

to nursing homes. By 2050 that number could be 6.6 million.11,116

 

2. A total of 20% of all deaths from all causes occur in nursing homes.117

 

3. Hip fractures are the single greatest reason for nursing home admissions.118

Nursing homes represent a reservoir for drug-resistant organisms due to overuse

of antibiotics.119

 

Congressman Waxman reminded us that “as a society we will be judged by how we

treat the elderly " when he presented a report that he sponsored, " Abuse of

Residents is a Major Problem in U.S. Nursing Homes, " on July 30, 2001. The

report uncovered that one third - 5,283 of the nations’ 17,000 nursing homes -

were cited for an abuse violation in the two-year period studied, January 1999 -

January 2001.116 Waxman stated that “the people who cared for us, deserve

better. " He also made it very clear that this was only the tip of the iceberg

and there is much more abuse occurring that we don’t know about or ignore.116a

 

The major findings of " Abuse of Residents is a Major Problem in U.S. Nursing

Homes, " were:

 

 

Over 30% of nursing homes in the U.S. were cited for abuses, totaling more than

9,000 abuse violations.

 

 

10% of nursing homes had violations that caused actual physical harm to

residents, or worse.

 

 

Over 40%, or 3,800 abuse violations were only discovered after a formal

complaint was filed, usually by concerned family members.

 

 

Many verbal abuse violations were found.

 

 

Occasions of sexual abuse.

 

 

Incidents of physical abuse causing numerous injuries such as fractured femur,

hip, elbow, wrist, and other injuries.

 

 

Dangerously understaffed nursing homes lead to neglect, abuse, overuse of

medications, and physical restraints. An exhaustive study of nurse-to-patient

ratios in nursing homes was mandated by Congress in 1990. The study was finally

begun in 1998 and took four years to complete.120 Commenting on the study, a

spokesperson for The National Citizens’ Coalition for Nursing Home Reform said,

“They compiled two reports of three volumes each thoroughly documenting the

number of hours of care residents must receive from nurses and nursing

assistants to avoid painful, even dangerous, conditions such as bedsores and

infections. Yet it took the Department of Health and Human Services and

Secretary Tommy Thompson only four months to dismiss the report as

‘insufficient.’”121 Bedsores occur three times more commonly in nursing homes

than in acute care or veterans’ hospitals.122 But we know that bedsores can be

prevented with proper nursing care. It shouldn’t take four years for someone to

find out

that proper care of bedsores requires proper staffing. In spite of such urgent

need in nursing homes where additional staff could solve so many problems, we

hear the familiar refrain “not enough research” - one that merely buys time for

those in charge and relegates another smoldering crisis to the back burner.

 

Since many nursing home patients suffer from chronic debilitating conditions,

their assumed cause of death is often unquestioned by physicians. Some studies

show that as many as 50% of deaths due to restraints, falls, suicide, homicide,

and choking in nursing homes may be covered up.123,124 It is quite possible that

many nursing home deaths are attributed, instead, to heart disease, which, until

our report, was the number one cause of death. In fact, researchers have found

that heart disease may be over-represented in the general population as a cause

of death on death certificates by 7.9% to 24.3%. In the elderly the

over-reporting of heart disease as a cause of death is as much as two-fold.125

 

When elucidating iatrogenesis in nursing homes, some critics have asked, “To

what extent did these elderly people already have life-threatening diseases that

led to their premature deaths anyway?” Our response is that if a loved one dies

one day, one week, one year, a decade, or two decades prematurely, thanks to

some medical misadventure, that is still a premature, iatrogenic death. In a

legalistic sense perhaps more weight is placed on the loss of many potential

years compared to an additional few weeks, but this attitude is not justified in

an ethical or moral sense.

 

The fact that there are very few statistics on malnutrition in acute-care

hospitals and nursing homes shows the lack of concern in this area. A survey of

the literature turns up very few American studies. Those that do appear are

foreign studies in Italy, Spain, and Brazil. However, there is one very

revealing American study conducted over a 14-month period that evaluated 837

patients in a 100-bed sub-acute-care hospital for their nutritional status. Only

8% of the patients were found to be well nourished. Almost one-third (29%) were

malnourished and almost two-thirds (63%) were at risk of malnutrition. The

consequences of this state of deficiency were that 25% of the malnourished

patients required readmission to an acute-care hospital compared to 11% of the

well-nourished patients. The authors concluded that malnutrition reached

epidemic proportions in patients admitted to this sub-acute-care facility.126

 

Many studies conclude that physical restraints are an underreported and

preventable cause of death. Whereas administrators say they must use restraints

to prevent falls, in fact, they cause more injury and death because people

naturally fight against such imprisonment. Studies show that compared to no

restraints, the use of restraints carries a higher mortality rate and economic

burden.127-129 Studies found that physical restraints, including bedrails, are

the cause of at least 1 in every 1,000 nursing-home deaths.130-132

 

However, deaths caused by malnutrition, dehydration, and physical restraints are

rarely recorded on death certificates. Several studies reveal that nearly half

of the listed causes of death on death certificates for older persons with

chronic or multi-system disease are inaccurate.133 Even though 1-in-5 people die

in nursing homes, the autopsy rate is only 0.8%.134 Thus, we have no way of

knowing the true causes of death.

 

Over-medicating Seniors

 

The CDC may be focused on reducing the number of prescriptions for children but

a 2003 study finds over-medication of our elderly population. Dr. Robert

Epstein, chief medical officer of Medco Health Solutions Inc. (a unit of Merck &

Co.), conducted the study on drug trends.135 He found that seniors are going to

multiple physicians and getting multiple prescriptions and using multiple

pharmacies. Medco oversees drug-benefit plans for more than 60 million

Americans, including 6.3 million senior citizens who received more than 160

million prescriptions. According to the study, the average senior receives 25

prescriptions annually. In those 6.3 million seniors, a total of 7.9 million

medication alerts were triggered: less than one-half that number, 3.4 million,

were detected in 1999. About 2.2 million of those alerts indicated excessive

dosages unsuitable for senior citizens, and about 2.4 million alerts indicated

clinically inappropriate drugs for the elderly. Reuters interviewed Kasey

Thompson, director of the Center on Patient Safety at the American Society of

Health System Pharmacists, who said, “There are serious and systemic problems

with poor continuity of care in the United States.” He says this study shows

“the tip of the iceberg” of a national problem.

 

According to Drug Benefit Trends, the average number of prescriptions dispensed

per non-Medicare HMO member per year rose 5.6% from 1999 to 2000 - from 7.1 to

7.5 prescriptions. The average number dispensed for Medicare members increased

5.5% - from 18.1 to 19.1 prescriptions.136 The number of prescriptions in 2000

was 2.98 billion, with an average per person prescription amount of 10.4

annually.137

 

In a study of 818 residents of residential care facilities for the elderly, 94%

were receiving at least one medication at the time of the interview. The average

intake of medications was five per resident; the authors noted that many of

these drugs were given without a documented diagnosis justifying their use.138

 

Unfortunately, seniors, and groups like the American Association for Retired

Persons (AARP), appear to be dependent on prescription drugs and are demanding

that coverage for drugs be a basic right.139 They have accepted the overriding

assumption from allopathic medicine that aging and dying in America must be

accompanied by drugs in nursing homes and eventual hospitalization with tubes

coming out of every orifice. Instead of choosing between drugs and a

diet-lifestyle change, seniors are given the choiceless option of either

high-cost patented drugs or low-cost generic drugs. Drug companies are

attempting to keep the most expensive drugs on the shelves and to suppress

access to generic drugs, in spite of stiff fines of hundreds of millions of

dollars from the government.140,141 In 2001 some of the world's biggest drug

companies, including Roche, were fined a record £523 million ($871 million) for

conspiring to increase the price of vitamins.142

 

We would urge AARP, especially, to become more involved in prevention of disease

and not to rely so heavily on drugs. At present, the AARP recommendations for

diet and nutrition assume that seniors are getting all the nutrition they need

in an average diet. At most, they suggest extra calcium and a multiple

vitamin/mineral supplement.143 This is not enough, and in our next report we

will show how to live a healthier life without unnecessary medical intervention.

 

We would like to send the same message to the Hemlock Society, which offers

euthanasia options to chronically ill people, especially those in severe pain.

What if some of these chronic diseases are really lifestyle diseases caused by

deficiency of essential nutrients, lack of care, inappropriate medication, or

lack of love? This question is extremely important to consider when you are

depressed or in pain. We must look to healing those conditions before offering

up our lives.

 

Let’s also look at the irony of under use of proper pain medication for patients

that really need it. For example, in one particular study pain management was

evaluated in a group of 13,625 cancer patients, aged 65 or over, living in

nursing homes. Overall, almost 30%, or 4,003 patients, reported pain. However,

more than 25% received absolutely no pain relief medication; 16% received a

World Health Organization (WHO) level-one drug (mild analgesic); 32% a WHO

level-two drug (moderate analgesic); and only 26% received adequate pain

relieving morphine. The authors concluded that older patients and minority

patients were more likely to have their pain untreated.144

 

The time has come to set a standard for caring for the vulnerable among us - a

standard that goes beyond making sure they are housed and fed, and not openly

abused. We must stop looking the other way and we, as a society, must take

responsibility for the way in which we deal with those who are unable to care

for themselves.

 

previous next

© 2003 Gary Null & Associates, Inc. (GNA)

 

 

 

 

NEW WEB MESSAGE BOARDS - JOIN HERE.

Alternative Medicine Message Boards.Info

http://alternative-medicine-message-boards.info

 

 

 

Free Pop-Up Blocker - Get it now