A chemical restraint is any drug used to control behavior in a manner not required to treat the medical or psychiatric condition. A Human Rights Watch (HRW) report released February 5, 2018, (“They Want Docile; How Nursing Homes in the United States Overmedicate People with Dementia”) reports that in an average week, over 179,000 U.S. nursing home residents are given psychotropic drugs, not because there is a diagnosis of mental illness, but rather to sedate the resident. That is chemical restraining.
Antipsychotic drugs can be helpful for people diagnosed with illnesses such as schizophrenia; however, in nursing homes they are too often used for their sedative effect. And what’s worse, when these drugs are used outside their FDA-approved manner, they can do more harm than good.
As far back as 2005, the FDA issued a “Black Box Warning”, its strongest warning, notifying healthcare professionals that antipsychotic drugs are not indicated for treatment of dementia-related psychosis and increase the risk of death. In 2008, the FDA stated that both conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychosis. Yet hundreds of thousands of nursing home residents with dementia throughout the country receive these drugs on a daily basis.
These drugs are often prescribed without first obtaining informed medical consent. To meet this legal requirement, the patient (or their representative) must be informed of the risks and benefits of the proposed drug, as well as alternatives to it. It is the doctor’s responsibility to obtain informed consent, and an explanation by a nursing home employee will not suffice. Absent a medical emergency, failure to receive informed consent prior to administering any medication may be deemed battery.
So, what can we do? First, know that, according the HRW’s report, only 5-10% of nursing home residents in Southern Oregon receive antipsychotic drugs (this figure does not differentiate between residents with or without a diagnosis for which the drug is appropriate). Second, know your rights, both as a patient and as an advocate for someone unable to speak for him or herself. Do not consent to the use of psychoactive drugs unless certain all other care treatment options have been exhausted. Insist on being provided written information on the adverse consequences of the proposed drugs, including any “Black Box Warnings”. Consider a second opinion from a trusted physician if any doubts remain. Periodically request a complete list of current medications from the facility and review them with a trusted physician.
Psychoactive drugs should always be the last resort for treating the symptoms of dementia. The signs of a good nursing home include treating the underlying medical problems, relieving pain, and doing everything possible for the residents to feel comfortable and at peace. We will explore this “culture of care” more deeply in the next article.