Stated in an article by NPR.org Old And Overmedicated: The Real Drug Problem In Nursing Homes, “Almost 300,000 nursing home residents are currently receiving antipsychotic drugs, usually to suppress the anxiety or aggression that can go with Alzheimer’s disease and other dementia.”
They go on to say, “Antipsychotics, however, are approved mainly to treat serious mental illnesses like schizophrenia and bipolar disorder. When it comes to dementia patients, the drugs have a black box warning, saying that they can increase the risk for heart failure, infections and death.”
The story is about Marie Sherman’s experience of placing her mother into a nursing home; “It wasn’t long before the nursing home staff told Manuel DeLeon, Beatrice’s husband, that his wife was agitated and they wanted to give her some medication for that. So he said OK. “They kept saying she was making too much noise, and that they give her this medicine to quiet her down,” he says.
Federal law prohibits the use of antipsychotics and other psychoactive drugs for the convenience of staff. It’s called a “chemical restraint.” There has to be a documented medical need for the drugs. “But they just kept giving her more and more,” says DeLeon, “and I noticed when I used to go see her, she’d just kind of mumble, like she was lost.”
Professor Henry Brodarty and colleagues in their study, Halting Antipsychotic use in Long Term care (HALT) Project propose a model for deprescribing antipsychotics in residential care through person-centred approaches to managing challenging behaviours. A targeted, evidence-based training package has been developed to up-skill general practitioners and nursing home staff in this area, as well as in the quality use of medicines.
After my horror story on Sundays blog, it is about time staff in the acute sector and aged care sector stopped allowing this abuse. The fact that antipsychotic drugs are in fact abuse and have been reported to have killed many people with dementia, and is not only incompatible with dementia, but in fact, dementia is the one contra-indication to them, seems often to be ignored totally…
I remain extremely sceptical about the use of the Behavioural and Psychological Symptoms of Dementia (BPSD) and believe the categorisation of behaviours into things like wandering, aggressive, absconder, screamer, poor feeders, and so on, simply increases the likelihood of person centred care not being delivered.
There is no respect or personhood when someone is called things such as wanderer, screamer or absconder…
The official category BPSD was the result of a consensus conference in Lansdowne in 1996, and interestingly this was sponsored by Janssen Pharmaceuticals, and it had a major impact on research, intervention, and definition of dementia. In terms of interventions, previously existing drugs, like the cognitive enhancers, began to be tested for non-cognitive outcomes such as activities of daily living, behavior, and global outcome (Leibing 2014).
It appears from this article that the term BPSD has been developed by pharmaceutical companies, and my simplistic and cynical consumer/student perspective suggests to me it was simply a way to define people with dementia in ways that can be managed by drugs, for example anti-anxiety or anti-agitation medications. People with dementia have been labelled disparagingly, to allow the prescribing of ‘behaviour’ modifying drugs, simply because of a failure of the pharmaceutical industry to find enough dementia (disease) modifying drugs and the lack of drugs for a cure.
Leibing, A 2014, The earlier the better: Alzheimer’s prevention, early detection, and the quest for pharmacological interventions, Culture, medicine and psychiatry, vol. 38, no. 2, pp. 217-236.