Drugging seniors at nursing homes is not a solution for funding shortfalls
By Nicole F. Bernier Evidencenetwork.caFeatures Clinical Patient Care
Sept. 26, 2014 – Those living in a regulated nursing home are likely in the frailest condition of their lives, and approaching the end of life. The individual reasons for entering a nursing home are many, but commonly, residents require intense personal care for an indefinite period of time. Nursing home residents often require significant assistance because many suffer from chronic conditions, which impair their capacity to live on their own. Residents rely heavily on the nursing home to ensure their protection and well-being.
So it is paradoxical – some would say tragic – that nursing home residents are too often put on drugs they don’t need, which can be dangerous, and may even kill them.
There is accumulating evidence that antipsychotic medication is used
excessively in some nursing homes. A recent Toronto Star investigation
revealed that many provincially-regulated nursing homes in Ontario are
routinely drugging their residents to calm and restrain them when they
are agitated, have a tendency to wander or display aggressive
behaviours. It also revealed that 33 per cent of Ontario’s nursing home
residents are on an antipsychotic drug.
While Ontario is
currently in the spotlight, similar headlines appear on a recurrent
basis across Canada. A recent report by the Canadian Institute for
Health Information found that the odds that a senior person living in a
Canadian nursing home will be given antipsychotics are nine times higher
than for the elderly living in the community. The report showed that
about 41 per cent of nursing home residents in Canada received at least
one antipsychotic in 2012.
How long will the elderly in nursing
homes be served unnecessary and potentially dangerous drugs when what
they actually need are better provisions for long-term care?
on drugs labels are unequivocal: for those who suffer from dementia,
antipsychotics are dangerous. These drugs, when inappropriately
prescribed in this manner, may increase the risk of death by 60 per cent
and can kill. Health Canada does not approve them for the elderly with
dementia, yet large numbers of nursing home residents on these drugs
suffer from this condition. Residents may also receive other drugs that
may be unnecessary and risky for them, such as the anti-anxiety
medication lorazepam or the antidepressant amitriptyline.
seniors remain calm and easy to manage is not what residents suffering
from dementia personally need the most from nursing homes, but this may
be what nursing homes need from them. The evidence suggests that in
several cases these facilities are using prescription drugs as a
cost-effective way to deal with their residents’ unwanted behaviours.
typically express concern when such issues are raised. Policymakers
establish new guidelines, promise to better educate doctors and
stakeholders and may even make data about drug use in nursing homes
publically accessible. Sadly, this has not been enough as evidenced by
the large numbers of seniors in these institutions who continue to take
unnecessary medications. More – and different – action is needed to
ensure an efficient response.
The evidence suggests that
behavioral interventions and improved management of dementia can
significantly reduce the need for antipsychotic medication. Such
solutions require better-designed, better-equipped and better-staffed
nursing homes. How well prepared are we to provide these conditions?
core problem lies in the largely insufficient funding levels for
nursing homes at the same time that this sector is facing a rapidly
growing demand for services. Significant investments will be needed for
nursing homes even if the goal is limited to maintaining the status quo.
Strong determination is needed from politicians and policymakers if
they seek to improve the current conditions.
But who will take
the lead? Provinces can certainly do better. But some of the tools
needed – including better funding and national standards for long-term
care – require a meaningful involvement from the federal government.
Effective leadership from the federal government is the essential first
There’s one thing we know for certain: Using prescription
drugs as a response to nursing home struggles with staffing shortages
and insufficient resources is not a solution.
Nicole F. Bernier is research director of the Faces of Aging program at the Institute for Research on Public Policy.
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