For Dementia Patients, Drugs Shouldn't Be Used to Control
I'm hearing, as a columnist, more questions about the use of medications to "calm" dementia patients. The Wall Street Journal recently ran an article titled Nursing Homes Struggle to Kick Drug Habit, written by Lucette Lagnado (discussed in a recent post by MK). Also, in the book "Old Age in a New Age," which I have reviewed on this site and will likely be referring to frequently, author Beth Baker cites drugs as a use of "restraint."
All of this brings back complicated memories for me. The nursing home my loved ones were in was a good one, and ahead of its time when it came to not over-medicating. I wasn't aware, at the time, how far ahead of their time they were. My dad's dementia was the result of a brain surgery that was supposed to prevent fluid from building up in his brain, due to a WWII brain injury. Generally, this surgery works. For whatever reason, it backfired on my dad, and he came out of surgery severely demented.
While still in the hospital, they put him on the powerful anti-psychotic drug Haldol. Since the hospital staff was still trying to convince us that the surgery was a success, and Dad hadn't changed, I thought it was odd that they saw fit to put him on Haldol.
One time, while I was visiting him in the hospital, he was semi-lucid, and the nurse came in to give him his dose of Haldol. Within twenty minutes, he was totally paranoid, telling me the male nurse tried to kill him in the shower (the same nurse he loved the day before surgery). He also tried to get me to take his dental plates home in my purse, as they were trying to "steal" them. This is progress? I fought until I won that battle. He was off Haldol when he left the hospital.
Then, Dad went to Rosewood. He was so determined to get up and do things for himself, even though his balance was horrible and his thinking muddled, that he was quite a challenge for the caregivers there. He had a walker and they wanted him to wait to walk when someone could walk with him, but there was no way to keep him down. On a day when he was energetic, he'd be off and racing his walker down the hall and no one was going to stop him.
He knew to use the call light to get help for the bathroom (during semi-awake times), but he'd get up and go into the bathroom himself, rather than wait for help. The nurse and I would discuss how to handle this and I was told any kind of restraint was out. I understood, as I'd seen what just a hint of restraint would do to him.
When he first went to the home, we did try putting a tray over his wheelchair arms, explaining that it would be easier when he ate. However, he was frantic when they did that, so we scrapped that idea. Putting up the bed rail was a recipe for disaster, as he'd try to get over it and fall. Never did they suggest that we use drugs to restrain him.
We discussed the fact that Dad still had choices. He needed to move. And even though his choices would surely get him hurt, that was a smaller price to pay than the mental anguish he experienced at the slight hint of restraining him.
Dad ended up breaking both hips and one wrist. It was painful for him and for us. However, it was a choice we made together, as we believed strongly in his right to make whatever choices he could. Add that to the fact that any kind of restraint put him in a much worse mental situation than he was already in, and it seemed our only option.
He did have a prescription for intense anxiety, to use on occasion, but it was tightly controlled. They were adamant that he not be given anything that would make him sleep too much. I thought this was normal nursing home procedure. Now, a few years down the road, I realize that it is not.
Many nursing homes are using drugs, rather than attention and choice, as a way to "control" dementia patients. The Wall Street Journal article, as well as Beth Baker's research, stressed that personal attention and time - taking time to find out what is bothering the person - was more effective than drugs.
I'm not saying that sedatives or even anti-psychotics should never be used. Every case is different. But I do agree with Beth Baker's research in that taking time to actually be with the dementia patient -actually trying to figure out what is making them anxious and then working to fix that - may make many anti-psychotics unnecessary. Will it take more staff time? Indeed it will. However, finding out what a dementia patient really needs is a sound investment of time and money. I
f, after careful study, it is determined a drug will help the patient, and not just make him or her "easier" to care for, than use the drug. But if the drug is for the convenience of staff, then it is a restraint, and that is illegal, and in some cases, immoral.