Nursing homes' reliance on drugs for behaviour

[Guest guest]

[the photo of Ernest Kambeitz's father that accompanied the article in the

print edition was shocking]

 

Nursing homes' reliance on drugs worries expert

Study shows widespread use of anti-psychotics to treat dementia

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20040504/DRUGS04/

 

By GLORIA GALLOWAY

 

UPDATED AT 9:30 AM EDT Tuesday, May. 4, 2004

 

 

One in four people admitted to a nursing home in Ontario who has not

previously been prescribed anti-psychotic drugs will be put on the

medication within a year. And almost 10 per cent of patients receiving the

drugs will be given doses higher than the recommended threshold.

 

Those are the startling findings of a study of 20,000 Ontarians conducted

between 1998 and 2000 by researchers at the Institute for Clinical

Evaluative Sciences. The researchers expect similar results would be

obtained across the country.

 

The anti-psychotic drugs, called neuroleptics, are generally prescribed to

treat schizophrenia. They are used in nursing homes to ease anxiety and

aggression in patients with dementia, but they come with a host of harmful

side effects.

 

" What was concerning about this study was how quickly people received these

therapies, " said Susan Bronskill, lead author of the study, which was

released yesterday. " We'd like to encourage people to look at

non-drug-related options first. "

 

Her concern, she said, is that use of the drugs among senior dementia

patients can bring on symptoms of Parkinson's disease, increase the

likelihood of debilitating falls, and even cause fatal strokes.

 

" Health Canada has issued a warning with two of the drug manufacturers

indicating that, for patients with dementia-related psychosis, the drugs

really aren't approved for use, " Dr. Bronskill said.

 

Doctors who prescribe the drugs say they recognize there are negative side

effects. But they also say there is simply no other way to treat some of

the more aggressive dementia patients who, without anti-psychotics, would

be a danger to the staff, other patients and themselves.

 

The study found 17 per cent of nursing home patients were prescribed the

anti-psychotic drugs within the first hundred days after admission, and 24

per cent were taking them within the first year. Only 14 per cent of the

patients who were dispensed the drugs had contact with a geriatrician or

psychiatrist 60 days before receiving the prescription.

 

While other jurisdictions, including the United States, have imposed limits

and regulations governing the use of anti-psychotics for senior patients,

similar restrictions do not exist in Canada, Dr. Bronskill said.

 

Older neuroleptics have largely been replaced with newer drugs called

atypical anti-psychotics that have fewer side effects. But the old drugs

continue to be prescribed and the new medication also produces some

negative symptoms.

 

The study came as no surprise to Ernest Kambeitz of Edmonton. His father,

Tom, was admitted to a nursing home in Lethbridge, Alta., several years ago

" and, against my wishes as the person holding the personal directive, they

did medicate him to the point where he was unable to function, " Mr.

Kambeitz said.

 

Within a couple of weeks, Tom Kambeitz changed from a man who, although

suffering from Alzheimer's disease, could walk, talk and recognize family

members to " a drooling vegetable who didn't recognize anyone. "

 

The farmer, who had rarely taken so much as an aspirin, fell repeatedly

while on the drugs, leaving him with bruises, a black eye and a broken

nose. He died a few months after entering the home at the age of 92. " He

never did come back, " his son said.

 

Bev McKay of Calgary, whose mother was administered medication against her

wishes after entering a nursing home, founded a group called Families

Allied to Influence Responsible Eldercare. " Families have been voicing this

concern for years and I find it sad that it's taken a research paper to

bring out the truth, " she said.

 

A woman in the group found a warning issued by drug manufacturer Eli Lilly

that said Zyprexa, the drug administered to her husband in a nursing home,

was associated with stroke and could prove fatal to elderly patients with

dementia.

 

The woman " copied [the warning] to the physician, copied it to the nursing

home staff, and they simply ignored it, " Ms. McKay said. " The physician

said that's nonsense, and would not even accept the information. "

 

Another woman, she said, was told that her mother would be drugged until

she was under control, even if that meant she wasn't able to swallow. That

continued " until the nurse phoned the family member and said, 'I cannot in

all conscience, continue to administer the medications.' "

 

Some people, Ms. McKay said, have been hospitalized in a comatose state as

a result of taking the anti-psychotics " only to be detoxified and returned

to the facility for more of the same. This is not only wrong, it's cruel

and I would suggest that it's even a criminal offence. "

 

Karen Sullivan is the executive director of the Ontario Long Term Care

Association, the group which represents the province's nursing homes. " From

what we can see of the study, it raises concerns, " she said yesterday.

 

But what the study fails to do, Ms. Sullivan said, is examine why the

medication is being prescribed in such abundance.

 

" We need to look into this more, " she said.

 

Will Molloy, a professor of medicine at McMaster University in Hamilton who

holds the St. Peter's-McMaster chair in aging, said he has problems with

studies like the one released yesterday because they do not provide context.

 

" Most of the people in nursing homes are [in] severe, late-stage dementia, "

Dr. Molloy said. They are in a nursing home because their families can no

longer care for them.

 

" Sixty per cent of those are aggressive. Fifty-seven per cent are paranoid,

they are resisting care, they have temper outbursts. This group is very

difficult to handle. "

 

But there are few treatments available for aggression, he said.

 

" In a nursing home, the staff get beaten up all the time and other

residents get pushed and it can be fatal, " Dr. Molloy said. Just last week,

a nurse who works with him was bitten on the hand by woman with Alzheimer's

who refused to unclench her teeth.

 

" You're caught between a rock and a hard place, " Dr. Molloy said of the

anti-psychotics. " They're not great, but they are the best we have right now. "