by CHARLES SCHMIDT
The rate of antipsychotic drug use in nursing homes has remained stubbornly high. Experts are concerned about misuse.
Jonathan Evans had finished his medical rounds at a local nursing home when he got a phone call. “Your patient is sexually inappropriate” a nurse at the facility told him. Evans is a geriatrician in Charlottesville, Virginia, and he had seen the patient, an elderly woman with mild dementia, earlier in the day. “She was fine,” he said. “Lovely visit.” The woman had since been discovered naked (but also alone) in another resident’s bedroom. The nurse, Evans said, wanted him to prescribe an antipsychotic “to make her behave.”
Evans denied the request. But he said the incident stuck with him as an example of how health care providers use drugs — including antipsychotics — as “chemical restraints” to control perceived behavioral problems. Evidence shows this is a widespread practice in nursing homes. A new analysis of more than 12,000 nursing homes by the Long Term Care Community Coalition, or LTCCC, a New York City-based nonprofit that advocates for elderly and disabled people in residential settings, found that more than one in five nursing home residents was being given an antipsychotic medication.
Antipsychotics have sedating effects and are justified only as treatments of last resort when behaviors such as agitation, aggression, or wandering become self-threatening to people with dementia or others around them, said Bruce Miller, a neurologist who directs the Memory and Aging Center at the University of California, San Francisco. But the LTCCC also found that hundreds of nursing homes around the country have drugging rates between 50 and 100 percent, raising what Richard Mollot, the organization’s executive director, described as “significant concerns about resident abuse and neglect.”
Dementia takes hold when nerve cells in the brain stop communicating normally and begin to die. As this occurs, people suffer progressive declines in cognitive and functional ability. Symptom onset varies from one form of dementia to the next. People with Alzheimer’s disease, for instance, lose memory first, while those with another neurodegenerative condition called Lewy body dementia may suffer sleep and behavioral disturbances at the outset and then memory losses later.
Many dementia patients suffer from depression, and episodes of agitation and aggression become more common as the disease progresses. Psychosis can also occur, often during dementia’s later stages. The delusions in dementia, however, are typically visual, whereas people with psychotic disorders, including schizophrenia, tend to experience auditory hallucinations, such as hearing voices.
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