Almost a third of nursing home residents are on antipsychotics:
And patients can be given the medicines, whether they are psychotic or not. The drugs are often used to calm demented patients, some with Alzheimer’s disease, and to help maintain order in nursing homes, which are often understaffed and reluctant to use physical restraints. But the FDA hasn’t approved the drugs for these uses, compounding the ethical questions.
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My cousin’s father had Alzheimer’s and ended up in a home.
He was pretty mobile until the very end and not always very cooperative. Managing him physically was one reason his wife couldn’t care for him anymore.
The nursing home was barred from physically restraining him, so sedating drugs were the only way they felt they had to manage him.
She ended up timing her visits so as to be there before he got his medication when he was not so sleepy.
She felt that physically restraining him might have been preferable as then he would have been more lucid.
As someone who used to work in an Alzheimer’s nursing home unit as an aide, it would be dangerous for the staff to constantly be dodging swinging arms and holding down kicking legs. Some patients would hit me every day with anything I needed to do, sometimes several times per day. Not all Alzheimers patients are 80-pound grannies.
Plus, the patients would not get necessary cares because staff would not be able to toilet them or change dressing or anything like that if they were constantly fighting and screaming. And, yes, it is against the law to restrain them, even to have side rails on their beds.
“And, yes, it is against the law to restrain them, even to have side rails on their beds”.
No rails on the beds? How many patients end up falling out of their beds and fracturing their hips?
If they are prone to falling off the bed, you put the bed mattress on the floor. That’s actually safer than a bedrail, and definitely safer than restraints.
These elderly Alzheimer patients sometimes strangle themselves getting caught up in the restraints or bedrails.
And yes, as nurse K points out, these Alzheimer patients sometimes become dangerous. They can get disinhibited as their Alzheimer’s progresses. I had one that laughed all the time. Everything was funny. I wish they were all like that.
Unfortunately, more often they are like my other Alzheimer’s patients. One ripped plumbing out of the walls. I really think he was trying to fix it in his mind. I’ve had them get physically aggressive, sexually aggressive, where they are a danger to themselves, to other patients, and to staff. I had an 85-year-old clock me in the face when he got delirious, man, that hurt for a week. They’re stronger than you think sometimes.
When they get like that, the nursing homes are within their rights to remove the patient from the facility. And they do….I’ve had a couple. They end up in the state psychiatric hospital. It’s dismal, and they do not live long when they go there. They’re restrained, heavily sedated, locked up, whatever it takes to keep them under control.
You have to balance that reality against the risk of the antipsychotics.
the WSJ article is so misleading in many ways:
1- implies that off-label use of drugs is rare & generally frowned upon. In fact, the reverse is true: probably MOST prescriptions are “off-label”; and often frequent off-label use proves to be useful for conditions not thought of originally;
2- “doctor” teigland is not an MD, but a statistician. the article implies that she is making a clinical judgment that patients are overmedicated, something she is not qualified to do.
3- ignores the reality of advanced alzheimer’s, which as previous posters pointed out, is unpleasant and even dangerous to staff at times.
4- ignores the option of families taking care of patients at home themselves (!) before blaming hard-working nurses, aides, and doctors for doing their best with an inevitably bad outcome.
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