by Special Guest Blogger – an Administrator
I have been a licensed and practicing administrator in California for many years. I have worked in several nursing homes. It has been my experience that it is perhaps too easy to administer psychotherapeutic drugs to nursing home residents. (1) State law requires that doctors obtain informed consent before administering psychotherapeutic drugs to nursing home residents. While some caring, attentive nursing home doctors do take the time to sit down and obtain informed consent from residents or families for these drugs, it is dramatically more common that doctors never talk to residents and/or their families about the side effects of these drugs, and/or reasonable alternatives to drug treatment.
(2) Federal nursing home regulations include 23 pages dedicated to limiting unnecessary drugs and psychotherapeutic drugs. Despite these lengthy regulations, in actual nursing home practice it is as easy to obtain physician orders for anti-psychotic medications as it is to obtain orders for an aspirin, or cough syrup. That is because, in my experience, regulators do not focus on enforcing unnecessary drug regulations, state or federal. Consider: only about one percent of state citations against nursing homes are issued for administration of unnecessary drugs.
In my opinion, the state does not focus a great deal of attention on enforcing unnecessary drug regulations because residents and families do not frequently complain to regulators about unnecessary drugs. That is because, in my experience, many residents and their families generally consider medications to be agents of health and recovery. We are a pill-popping culture, and it is uncommon for Americans to imagine that medications can harm people. However, emerging research on psychoactive drugs, and anti-psychotic drugs in particular, indicates that psychoactive drugs can and do harm the brain, especially in the elderly. [Thank you CANHR for highlighting some of this research.] Antipsychotics have been shown to induce brain pathology and make patients more prone to psychosis. (Whitaker, 2002)
My advice to any person considering the administration of psychoactive drugs (including anti-depressants) to an elder who lives in a nursing home is: get educated and consider alternatives. Get educated to the fact that, while some drugs can be helpful, many drugs can be harmful, especially when used long-term in the elderly. Explore alternatives to treatment, including modifying the environment, and enhancing nutrition and hydration. Explore also the issue of depression: it is common to be depressed about living in a nursing home. Depression manifests in many ways, including what some nursing home staff may consider inappropriate behavior. If your family member who lives in a nursing home appears to be depressed, then consider ways in which your family member can be engaged about her depression and/or associated behaviors, without resorting to popping a pill that may induce long-term brain pathology. Might increased socialization help your family member’s possible depression? Consider spiritual issues too, and the potential need for your family member who is a nursing home resident to engage someone–perhaps even a mental health professional–about feelings of fear and rage.
It is my long experience that many nursing home residents are (understandably) full of rage. That rage frequently manifests in behaviors. The behaviors in turn frequently are treated with psychoactive drugs. But, at root, many of these residents don’t need drugs for their behaviors; they need someone to bear witness to their rage. In sum, then, I think it is best to think about psychoactive drugs as last options for nursing home residents, instead of first options.