Social Policy in Ontario

Government still lets nursing homes improperly drug seniors

Posted on May 19, 2016 in Health Delivery System

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TheStar.com – Opinion/Commentary – Doping seniors with antipsychotic drugs can be both dangerous and illegal. Yet government allows it anyway.
May 18, 2016.   By THOMAS WALKOM National Affairs Columnist

The common nursing-home practice of doping seniors with powerful antipsychotic drugs is both dangerous and overdone.

In a good many cases, it is almost certainly illegal.

And yet the provincial government allows it to persist.

This is one of the depressing conclusions that can be drawn from the most recent attempt to address the problem, this one mounted by the federally funded Canadian Foundation for Healthcare Improvement.

The foundation took the radical step of persuading 56 nursing homes across Canada to review the medication prescribed to clients suffering from dementia. To the surprise of few, it turned out more than half of the 416 seniors sampled were being given antipsychotics for little or no medical reason.

When the drugs were cut back — or in 36 per cent of the cases phased out entirely — the residents were healthier, happier and less troublesome.

As CFHI vice-president Stephen Samis told my Star colleague Jacques Gallant, nursing homes too often use antipsychotic drugs as “chemical straitjackets” to keep their residents docile.

The good news from this study is that 56 nursing homes were persuaded to do something they should have done anyway: review the medication prescribed their clients to make sure it was appropriate.

The bad news is that provincial governments — including Ontario’s — aren’t requiring them to do so.

There is nothing novel about the drugged seniors story. It’s been going on for years. The Star has been reporting on it for years.

At the centre of it is money. Old people suffering from dementia can be difficult. Those with more serious mental problems can be dangerous.

But the cheapest way for cash-strapped nursing homes to deal with anyone who gives any kind of trouble — from the frail woman who mischievously spills her apple juice on the floor to the big man full of rage — is to dope the miscreant with heavy-duty antipsychotics.

The pharmaceutical companies know this is dangerous and provide stern warnings with their products. Antipsychotics can lead to heart attacks, strokes and sudden death. They also tend to increase the sense of confusion in a person already experiencing dementia.

Yet some doctors insist on prescribing them anyway for so-called off-label conditions like dementia.

One study published in the Canadian Medical Association Journal found that, despite manufacturers’ warnings, overall use of antipsychotics by Ontario seniors increased by 20 per cent between 2000 and 2007.

Jane Meadus, a lawyer with Toronto’s Advocacy Centre for the Elderly, notes that some complaints of faulty prescribing have been made to regulators at the College of Physicians and Surgeons of Ontario, but with no discernable effect.

In Ontario, it is illegal for nursing homes to use chemical straitjackets — unless a client or staff member is at immediate risk. But it is not illegal for a nursing home to request that a physician authorize “treatment” in the form of anti-psychotics. So that’s what many do.

“Ongoing chemical restraint is disguised as some sort of treatment,” says Meadus.

Theoretically, this shouldn’t happen. Theoretically, nursing home clients (or their proxies) are required by law to give informed consent before being prescribed any medication.

But Meadus says that often doesn’t happen. Family members are reluctant to question the nursing home. In some cases, the home threatens to expel clients who won’t go along with the recommended drug regime.

That too is illegal, says Meadus. But it occurs anyway.

The bizarre element in all of this is that, as CFHI found, eliminating unnecessary antipsychotics can save the health system money. Old people who are not drugged fall less and break fewer bones. The threat of suffering an expensive complication, such as a stroke, is also reduced. There is less need for pricey acute hospital care.

A similar study in Alberta found that regular medication reviews coupled with directives to have staff deal with clients more appropriately (don’t suddenly surprise them; treat them as adults) cut antipsychotic use in half — without costing the nursing homes more.

In short, this is one of those problems that should be fixable. It requires government to enforce its own laws. It requires physicians to prescribe properly. It requires nursing homes – and the rest of us – to remember that old people with dementia aren’t just lumps waiting to die.

< https://www.thestar.com/opinion/commentary/2016/05/18/government-still-lets-nursing-homes-improperly-drug-seniors-walkom.html >

Tags: disabilities, Health, mental Health, participation, pharmaceutical, rights, standard of living

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