As we age, medical problems often crop up, and as a result, most of us receive and fill more prescriptions. At the point when someone is admitted to a nursing home or skilled nursing facility, it’s not at all unusual for them to have five or even 10 different active prescriptions. The most common ones are Lasix, Synthroid, Lisinopril, Zoloft, Aricept, Ativan, Seroquel and Coumadin – which treat a range of problems from depression to congestive heart failure, high blood pressure, and blood clots.
Invariably, once someone is admitted to a facility, new problems crop up, and new prescriptions are added. If a pharmacist or medical professional isn’t paying close attention, side effects from one drug can cause a new drug to be prescribed. In turn, new and unintended side effects from the combination appear.
Compounding the problem is the common misconception that as we age we become more forgetful and our minds aren’t as sharp. Grandma suffers from memory loss. How do we know? Because she tells the same stories over and over, and sometimes she seems disoriented. Senility is commonly thought to be a normal sign of aging but the truth is that dementia and cognitive decline are not normal. According to the CDC, as many as 6 million people in the US are thought to have some form of dementia, but many more are incorrectly diagnosed. Instead, they may have a vitamin deficiency ora mixture of drugs in their system, called polypharmacy, which may make it seem that they have dementia.
In nursing homes, residents who are disruptive, or loud, or difficult to control, or who are sometimes just not nice to nursing staff, are often sedated, tranquilized, or medicated into a state of submission. In some cases, doctors and pharmacists write and fill prescriptions on the advice of nursing staff who are not even qualified to render medical opinions. Patients are given multiple drugs that suppress the central nervous system, or that are psychotropic, meaning they are given to change someone’s mood. The drugs are given purely for staff convenience, and not because the resident needs the medication for quality of life.
A classic sign of polypharmacy is the use of drugs as a “chemical restraint.” How can you tell?You’ll see a nursing home resident in a hallway with their head cocked to the side, their mouth open and drooling, and they have an empty stare in their eyes. Another tell-tale sign is when someone goes to see their loved one at a facility during the day and they have a hard time rousing them – they’ll be asleep, lethargic, or unresponsive during normal waking hours.
The real story in such cases is that facilities don’t have enough staff, so the staff is overworked, and it’s just a lot easier to drug ‘em instead of helping ‘em.
If you backchain in the records before such drugs are given, you’ll see a common series of events leading up. There will be comments such as:
“Resident wants to go out.”
“Resident wants to leave the building.”
“Resident won’t follow my direction or guidance.”
“Resident was agitated.”
Or, get this one:
“The 86-year-old resident is combative.”
It boggles my mind when I read that an 80 pound 86-year-old is “combative” with caregivers – but I see such comments all the time!
Fortunately, because of Federal and State regulations, there are legal protections that have been put in place for seniors in nursing facilities that are there to prevent what is known as “chemical restraints,” which means drugging residents for staff convenience.
These cases don’t have to happen. If you see such tell-tale signs of polypharmacy, give us a call at (916) 643-2200. We may be able to help.