Thursday, July 20, 2017 by Isabelle Z.
It’s hard not to feel the overwhelming urge to take the best care of yourself possible when you hear what happens to elderly people in nursing homes. While horror stories involving specific incidents of mistreatment hit the headlines every now and then and can be extremely disturbing, a much more insidious problem is doing even more harm to nursing home residents: overmedication.
The latest study out of Norway shows just how extensive this problem is. When researchers studied the medical records of around 1,000 Norwegian nursing home residents over the course of six years and interviewed their relatives using questionnaires, they found that medication use for mental illness was remarkably high whether residents had dementia or not.
Patients who showed symptoms like hallucinations, aggressive behavior, and irritability were more likely to be given psychotropic drugs. In addition, they noted that many patients continued to take these medications even after their symptoms improved, placing them at a higher risk of falls, strokes, and even early death.
The lead author of the study, which was published in the journal BMC Geriatrics, said that antipsychotics should not be the first option for treatment and that when they are used, they should be given for the minimum amount of time possible. Anne-Sofie Helvik said that the main focus should be on high-quality nursing care instead of medication. She pointed out that doctors typically only spend a few hours at a time attending to patients in nursing homes, which means they rely on information given to them by nursing home staff members. That’s why she feels the nurses in charge of these patients need to have a good system in place for observing their symptoms and relaying relevant information to doctors so they can make choices that are in the patients’ best interest.
The study also found that those living in nursing homes for longer periods of time had a bigger chance of being prescribed antipsychotic or anxiolytic drugs. She theorizes that new residents sometimes get extra attention while they are getting acclimated, while those who have been there longer might not get the same amount of attention and follow-up.
In addition, those living in bigger nursing homes took anti-anxiety meds for longer periods and more often than residents of smaller homes. While the study didn’t identify a specific explanation, Helvik feels the noise levels in these facilities might add to anxiety in those living there.
She also pointed to high staff turnover in some nursing homes, which can impact the continuing of care and follow-up. She said that nurses need greater knowledge when it comes to understanding patients’ needs and a strong understating of the side effects of drugs.
Cost could also be a factor. The head of the Norwegian Association for Retirement and Nursing Medicine, physical Kjellaug Enoksen, said that medicating patients is cheaper than hiring caregivers to take on extra shifts, and she echoed the sentiment that caregivers need better training.
Overmedication in nursing homes is also a problem in the U.S., where data shows that more than 123,000 patients died as a result of overmedication in 2014 alone. This is particularly alarming when you consider the fact that more than a third of ER visits for drug reactions involve patients who are 65 or older, a percentage that has risen dramatically since 2005-2006 when just 26 percent of such visits involved elderly patients. Antipsychotics and opioids are just a few of the drugs behind this rise. Allergic reactions to antibiotics and hemorrhages from anticoagulants were just a few of the common medication-related problems sending older adults to the hospital.
Even though antipsychotics aren’t approved for dementia patients, one third of those with dementia who spend more than 100 days in nursing homes are given the drugs, which raise their risk of mortality and cause problems like movement disorders and low blood pressure. This, in turn, prompts them to take even more drugs to correct these side effects, creating a vicious cycle of overmedication – and sizeable profits for Big Pharma. Doesn’t our older generation deserve better?